Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | IL | |
N | 1223P0300X | Periodontist | IL |
NPI | 1003939992 |
---|---|
Provider Name | Dr. Lorelei Lynne Grise' |
First Address | Arlington Heights, IL 60005-2728 |
Second Address | Arlington Heights, IL 60004-6059 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2007 |
Last Update Date | 08/07/2007 |