Provider Demographics
NPI:1528589090
Name:REEN, GURSIMRAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:GURSIMRAN
Middle Name:
Last Name:REEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4133 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2141
Mailing Address - Country:US
Mailing Address - Phone:330-423-3528
Mailing Address - Fax:
Practice Address - Street 1:3057 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3548
Practice Address - Country:US
Practice Address - Phone:773-257-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012782A1223G0001X
IL0190313951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice