Provider Demographics
NPI:1134296551
Name:GASPARAITIS, VINCENT A JR (DDS)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:A
Last Name:GASPARAITIS
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3338 N HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-3601
Mailing Address - Country:US
Mailing Address - Phone:773-637-8696
Mailing Address - Fax:773-637-8688
Practice Address - Street 1:3338 N HARLEM AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-3601
Practice Address - Country:US
Practice Address - Phone:773-637-8696
Practice Address - Fax:773-637-8688
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice