Provider Demographics
NPI:1972757144
Name:DIGENNARO, GLORIA A (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:A
Last Name:DIGENNARO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:666 DUNDEE RD STE 801
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2734
Mailing Address - Country:US
Mailing Address - Phone:847-291-0555
Mailing Address - Fax:847-291-6933
Practice Address - Street 1:666 DUNDEE RD STE 801
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2734
Practice Address - Country:US
Practice Address - Phone:847-291-0555
Practice Address - Fax:847-291-6933
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190182881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice