Provider Demographics
NPI:1164798864
Name:DURAES, GABRIELA V (DDS)
Entity Type:Individual
Prefix:DR
First Name:GABRIELA
Middle Name:V
Last Name:DURAES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:GABRIELA
Other - Middle Name:VERSIANI
Other - Last Name:DURAES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:156 E LAKE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1184
Mailing Address - Country:US
Mailing Address - Phone:630-295-9600
Mailing Address - Fax:630-735-2712
Practice Address - Street 1:156 E LAKE ST
Practice Address - Street 2:SUITE A
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1184
Practice Address - Country:US
Practice Address - Phone:630-295-9600
Practice Address - Fax:630-735-2712
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0289211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice