Provider Demographics
NPI:1861648818
Name:GINA L. TAMBORNINI DDS INC
Entity Type:Organization
Organization Name:GINA L. TAMBORNINI DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:TAMBORNINI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-642-4218
Mailing Address - Street 1:1640 N WELLS ST.
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-6006
Mailing Address - Country:US
Mailing Address - Phone:312-642-4218
Mailing Address - Fax:312-642-6419
Practice Address - Street 1:1640 N WELLS ST.
Practice Address - Street 2:SUITE 205
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-6006
Practice Address - Country:US
Practice Address - Phone:312-642-4218
Practice Address - Fax:312-642-6419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0192032061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty