Provider Demographics
NPI:1326242884
Name:ROSSINO, PERRY E (DDS)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:E
Last Name:ROSSINO
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 1:9101 S CICERO AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-1804
Mailing Address - Country:US
Mailing Address - Phone:708-423-0940
Mailing Address - Fax:708-423-0980
Practice Address - Street 1:9101 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-1804
Practice Address - Country:US
Practice Address - Phone:708-423-0940
Practice Address - Fax:708-423-0980
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0188031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice