Provider Demographics
NPI:1609259423
Name:SARABIA, LOUISE (DDS)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:SARABIA
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 1:1500 W MONROE ST
Mailing Address - Street 2:UNIT403
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2413
Mailing Address - Country:US
Mailing Address - Phone:718-607-1754
Mailing Address - Fax:
Practice Address - Street 1:12121 WESTERN AVE
Practice Address - Street 2:#3
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-1385
Practice Address - Country:US
Practice Address - Phone:708-293-7773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL000000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist