Provider Demographics
NPI:1851083331
Name:BRIGANDO, GABRIELLA TATIANA (DMD, MBS)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:TATIANA
Last Name:BRIGANDO
Suffix:
Gender:F
Credentials:DMD, MBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 S 85TH CT
Mailing Address - Street 2:
Mailing Address - City:HICKORY HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60457-1331
Mailing Address - Country:US
Mailing Address - Phone:708-217-4465
Mailing Address - Fax:
Practice Address - Street 1:1355 N GALENA AVE
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-1009
Practice Address - Country:US
Practice Address - Phone:815-284-1995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0342061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice