Provider Demographics
NPI:1821462508
Name:DR. GENE A. REISINGER DDS, LLC.
Entity Type:Organization
Organization Name:DR. GENE A. REISINGER DDS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:REISINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-383-9099
Mailing Address - Street 1:1122 WESTGATE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1170
Mailing Address - Country:US
Mailing Address - Phone:708-383-9099
Mailing Address - Fax:708-383-9978
Practice Address - Street 1:1122 WESTGATE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1170
Practice Address - Country:US
Practice Address - Phone:708-383-9099
Practice Address - Fax:708-383-9978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019015411122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty