Provider Demographics
NPI:1811009046
Name:PICCIONI, GINA MARIE (DMD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:PICCIONI
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 1:7700 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305
Mailing Address - Country:US
Mailing Address - Phone:708-366-6760
Mailing Address - Fax:708-366-6762
Practice Address - Street 1:7700 W MADISON ST
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305
Practice Address - Country:US
Practice Address - Phone:708-366-6760
Practice Address - Fax:708-366-6762
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist