Provider Demographics
NPI:1962548172
Name:TALENTOWSKI, DIANE R (DDS)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:R
Last Name:TALENTOWSKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 HILLGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1442
Mailing Address - Country:US
Mailing Address - Phone:708-246-8887
Mailing Address - Fax:708-246-6858
Practice Address - Street 1:518 HILLGROVE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1442
Practice Address - Country:US
Practice Address - Phone:708-246-8887
Practice Address - Fax:708-246-6858
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL01902060031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice