Provider Demographics
NPI:1679775225
Name:SHURILLA, GREGORY K (DDS)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:K
Last Name:SHURILLA
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 1:8108 W 143RD STREET
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2310
Mailing Address - Country:US
Mailing Address - Phone:708-460-8827
Mailing Address - Fax:708-460-6949
Practice Address - Street 1:8108 W 143RD STREET
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2310
Practice Address - Country:US
Practice Address - Phone:708-460-8827
Practice Address - Fax:708-460-6949
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist