Provider Demographics
NPI:1083073738
Name:TAMMY GIANNETTA DDS
Entity Type:Organization
Organization Name:TAMMY GIANNETTA DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GIANNETTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-524-5053
Mailing Address - Street 1:16121 S FARRELL RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-8200
Mailing Address - Country:US
Mailing Address - Phone:815-524-5053
Mailing Address - Fax:815-552-2064
Practice Address - Street 1:16121 S FARRELL RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-8200
Practice Address - Country:US
Practice Address - Phone:815-524-5053
Practice Address - Fax:815-552-2064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-026431261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental