Provider Demographics
NPI:1164687471
Name:GIRALDO, GLORIA H (DDS)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:H
Last Name:GIRALDO
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 1:1130 N DEARBORN ST
Mailing Address - Street 2:APT 2201
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-2756
Mailing Address - Country:US
Mailing Address - Phone:305-300-9384
Mailing Address - Fax:
Practice Address - Street 1:1130 N DEARBORN ST
Practice Address - Street 2:APT 2201
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-2756
Practice Address - Country:US
Practice Address - Phone:305-300-9384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0276441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice