Provider Demographics
NPI:1598884330
Name:PAOLUCCI-DELSASSO, REGINA MARY (DDS)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:MARY
Last Name:PAOLUCCI-DELSASSO
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 1:1960 ESSINGTON RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-1616
Mailing Address - Country:US
Mailing Address - Phone:815-436-8660
Mailing Address - Fax:815-577-0189
Practice Address - Street 1:1960 ESSINGTON RD
Practice Address - Street 2:SUITE 105
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-1616
Practice Address - Country:US
Practice Address - Phone:815-436-8660
Practice Address - Fax:815-577-0189
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0213081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice