Provider Demographics
NPI:1205843356
Name:STRATHDEE, GENE DOUGLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:DOUGLAS
Last Name:STRATHDEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 2ND ST W
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:IL
Mailing Address - Zip Code:61264-2743
Mailing Address - Country:US
Mailing Address - Phone:309-787-5992
Mailing Address - Fax:309-787-8283
Practice Address - Street 1:527 2ND ST W
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:IL
Practice Address - Zip Code:61264-2743
Practice Address - Country:US
Practice Address - Phone:309-787-5992
Practice Address - Fax:309-787-8283
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190159141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice