Organization Name: | GILBERT J LAFEMINA DDS LTD |
NPI Number: | 1003112632 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GILBERT J LAFEMINA (PRESIDENT) |
Mailing Address: | 345 E Burlington St Riverside |
State: | IL US |
Postal Code: | 605462188 |
Phone Number: | 7084476670 |
Fax Number: | 7084476673 |
NPI Enumeration Date: | 01/29/2011 |
NPI Last Update Date: | 12/16/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 019015136 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |