Provider Demographics
NPI:1245975101
Name:DIPILLA DENTISTRY OF LINCOLN PARK
Entity type:Organization
Organization Name:DIPILLA DENTISTRY OF LINCOLN PARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIER
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSILIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-615-6865
Mailing Address - Street 1:1009 WEST WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1009 WEST WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3502
Practice Address - Country:US
Practice Address - Phone:313-246-8288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-04
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty