| Gerald | |
|
1016 Michaels Ln Libertyville IL 60048-3715 | |
| (847) 902-8305 | |
| Not Available |
| Full Name | Gerald |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1016 Michaels Ln, Libertyville, Illinois |
| Authorized Official Name and Position | Gerald A Dismer (OWNER) |
| Authorized Official Contact | 8479028305 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gerald 1016 Michaels Ln Libertyville IL 60048-3715 Ph: (847) 902-8305 | Gerald 1016 Michaels Ln Libertyville IL 60048-3715 Ph: (847) 902-8305 |
| NPI Number | 1578952065 |
|---|---|
| Provider Enumeration Date | 01/21/2015 |
| Last Update Date | 01/21/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578952065 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 019015751 (Illinois) | Primary |
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