Organization
GERALD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERALD A DISMER DDS (OWNER)
(847) 902-8305
Entity
Organization
Contact information
Practice address
1016 MICHAELS LN, LIBERTYVILLE, IL 60048-3715
(847) 902-8305
Mailing address
1016 MICHAELS LN, LIBERTYVILLE, IL 60048-3715
(847) 902-8305
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019015751
IL
Other
Enumeration date
01/21/2015
Last updated
01/21/2015
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