Provider Demographics
NPI:1861802514
Name:IRENE GULA DDS, PC
Entity type:Organization
Organization Name:IRENE GULA DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:GULA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-631-6802
Mailing Address - Street 1:6304 N NAGLE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-3614
Mailing Address - Country:US
Mailing Address - Phone:773-631-6802
Mailing Address - Fax:
Practice Address - Street 1:6304 N NAGLE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-3614
Practice Address - Country:US
Practice Address - Phone:773-631-6802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-03
Last Update Date:2014-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL091025314122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty