Organization Name: | TAMMY GIANNETTA DDS |
NPI Number: | 1083073738 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TAMMY GIANNETTA (DENTIST/OWNER) |
Mailing Address: | 16121 S Farrell Rd Lockport |
State: | IL US |
Postal Code: | 604418200 |
Phone Number: | 8155245053 |
Fax Number: | 8155522064 |
NPI Enumeration Date: | 02/22/2016 |
NPI Last Update Date: | 02/22/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 019-026431 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |