Provider Demographics
NPI:1295986834
Name:GASIOR, ANNETTE LOUISE (DDS)
Entity type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:LOUISE
Last Name:GASIOR
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 1:6820 S. PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:ID
Mailing Address - Zip Code:60629
Mailing Address - Country:US
Mailing Address - Phone:773-581-4627
Mailing Address - Fax:773-581-3155
Practice Address - Street 1:6820 S. PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:ID
Practice Address - Zip Code:60629
Practice Address - Country:US
Practice Address - Phone:773-581-4627
Practice Address - Fax:773-581-3155
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0250971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice