Provider Demographics
NPI:1083815260
Name:CULLIGAN, TARA ANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:ANNE
Last Name:CULLIGAN
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 1:2131 N LEAVITT ST
Mailing Address - Street 2:#2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3272
Mailing Address - Country:US
Mailing Address - Phone:773-486-6779
Mailing Address - Fax:
Practice Address - Street 1:4747 N HARLEM AVE
Practice Address - Street 2:SUITE D
Practice Address - City:HARWOOD HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60706-4600
Practice Address - Country:US
Practice Address - Phone:708-867-4700
Practice Address - Fax:708-867-8107
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice