Provider Demographics
NPI:1164719944
Name:TRIPLEDOC CORP
Entity Type:Organization
Organization Name:TRIPLEDOC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.D.S.
Authorized Official - Prefix:
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:
Authorized Official - Last Name:STORNIOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-456-0800
Mailing Address - Street 1:8524 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:NORRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60706-2956
Mailing Address - Country:US
Mailing Address - Phone:708-456-0800
Mailing Address - Fax:708-456-8889
Practice Address - Street 1:8524 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:NORRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60706-2956
Practice Address - Country:US
Practice Address - Phone:708-456-0800
Practice Address - Fax:708-456-8889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190205861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty