Provider Demographics
NPI:1346319472
Name:PULEO, JOSEPHINE E (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:E
Last Name:PULEO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 E KATHLEEN DR
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-2737
Mailing Address - Country:US
Mailing Address - Phone:312-613-4715
Mailing Address - Fax:
Practice Address - Street 1:28W530 BATAVIA RD
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-3022
Practice Address - Country:US
Practice Address - Phone:630-393-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190267391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9184845Medicaid