Provider Demographics
NPI:1447690326
Name:GURGONE, PHILIP ANTHONY (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ANTHONY
Last Name:GURGONE
Suffix:
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 1:14624 WOOD DUCK CT
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-8814
Mailing Address - Country:US
Mailing Address - Phone:708-362-1509
Mailing Address - Fax:
Practice Address - Street 1:501 W GOLF RD
Practice Address - Street 2:SUITE B
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60195-3500
Practice Address - Country:US
Practice Address - Phone:847-805-6202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190294821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice