Provider Demographics
NPI:1447265970
Name:GSDC INC
Entity type:Organization
Organization Name:GSDC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARISMA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUAT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-588-4650
Mailing Address - Street 1:3524 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3210
Mailing Address - Country:US
Mailing Address - Phone:773-588-4650
Mailing Address - Fax:773-588-4631
Practice Address - Street 1:3524 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3210
Practice Address - Country:US
Practice Address - Phone:773-588-4650
Practice Address - Fax:773-588-4631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization