Gerald Joseph Ciebien, DDS
Individual provider Active NPI Dentist · Riverside, IL
NPI 1942648845 · NPPES record last updated Jun 13, 2013
Key facts
- NPI
- 1942648845
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 019.015930 (IL)
- Practice address
- 197 N. Delaplaine Rd.
Riverside, IL 60546 - Phone
- (708) 442-5740
- NPI assigned
- Jun 13, 2013
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.015930 | IL | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019.015930 | IL | Yes |
Addresses
Primary practice location
197 N. Delaplaine Rd.
Riverside, IL 60546
Mailing address
197 N. Delaplaine Rd.
Riverside, IL 60546
Phone (708) 442-5740
Other providers in Riverside, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.