Individual
GERALD LEON WINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2632 W DIVISION ST, CHICAGO, IL 60622
(773) 235-0980
(773) 235-1249
Mailing address
2632 W DIVISION ST, CHICAGO, IL 60622
(773) 235-0980
(773) 235-1249
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019013232
IL
Other
Enumeration date
01/29/2007
Last updated
07/08/2007
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