Provider Demographics
NPI:1356475032
Name:GORIN, DOUGLAS V (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:V
Last Name:GORIN
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 1:111 N WABASH AVE STE 919
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-1932
Mailing Address - Country:US
Mailing Address - Phone:312-641-2575
Mailing Address - Fax:312-641-6621
Practice Address - Street 1:111 N WABASH AVE STE 919
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1932
Practice Address - Country:US
Practice Address - Phone:312-641-2575
Practice Address - Fax:312-641-6621
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics