Individual
JERI JANNINE COFFEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
24 WOODSIDE RD, RIVERSIDE, IL 60546-2494
(708) 442-0115
(708) 442-8192
Mailing address
24 WOODSIDE RD, RIVERSIDE, IL 60546-2494
(708) 442-0115
(708) 442-8192
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
19-17602
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19-17602
STATE OF IL PROVIDER LISC
IL
Enumeration date
01/22/2007
Last updated
07/08/2007
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