Provider Demographics
NPI:1225251614
Name:GAMALINDA, PURIFICACION RIZO
Entity Type:Individual
Prefix:DR
First Name:PURIFICACION
Middle Name:RIZO
Last Name:GAMALINDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3038 W JARLATH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-1128
Mailing Address - Country:US
Mailing Address - Phone:773-764-1924
Mailing Address - Fax:
Practice Address - Street 1:2346 W DEVON AVE
Practice Address - Street 2:2ND FLR.
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-2011
Practice Address - Country:US
Practice Address - Phone:773-465-4010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice