Provider Demographics
NPI:1407161185
Name:CEPULENAITE, REDA
Entity Type:Individual
Prefix:
First Name:REDA
Middle Name:
Last Name:CEPULENAITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REDA
Other - Middle Name:
Other - Last Name:CEPULENAITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:25 E WASHINGTON ST STE 1300
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-1802
Mailing Address - Country:US
Mailing Address - Phone:312-368-6400
Mailing Address - Fax:312-368-6426
Practice Address - Street 1:25 E WASHINGTON ST STE 1300
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1802
Practice Address - Country:US
Practice Address - Phone:312-368-6400
Practice Address - Fax:312-368-6426
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0282921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice