Provider Demographics
NPI:1003939992
Name:GRISE', LORELEI LYNNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LORELEI
Middle Name:LYNNE
Last Name:GRISE'
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 1:848 S BRISTOL LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2728
Mailing Address - Country:US
Mailing Address - Phone:847-797-1832
Mailing Address - Fax:
Practice Address - Street 1:439 LAKE ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-1472
Practice Address - Country:US
Practice Address - Phone:847-395-3250
Practice Address - Fax:847-395-4045
Is Sole Proprietor?:No
Enumeration Date:2007-04-07
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019022485122300000X
IL0210016481223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist