Organization
GILBERT J LAFEMINA DDS LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GILBERT J LAFEMINA (PRESIDENT)
(708) 447-6670
Entity
Organization
Contact information
Practice address
345 E BURLINGTON ST, RIVERSIDE, IL 60546-2188
(708) 447-6670
(708) 447-6673
Mailing address
345 E BURLINGTON ST STE B1, RIVERSIDE, IL 60546-2084
(708) 447-6670
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019015136
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6489850001
PTAN
IL
Enumeration date
01/29/2011
Last updated
12/16/2011
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