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NPI Code Detail

MEDICARE: GARY L. MONSON, D.D.S., P.C.

MEDICARE: GARY L. MONSON, D.D.S., P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry019019236IL

General Provider Information

NPI Number : 1013363498
Entity Type Code : Organization
Provider Name (Legal Business Name) : GARY L. MONSON, D.D.S., P.C.
Provider Business Mailing Address
First Line : 5358 N BROADWAY ST
Second Line :
City : CHICAGO
State : IL
Zip : 60640-2312
Country : US
Telephone Number : 312-263-2483
Fax Number :
Provider Business Practice Location Address
First Line : 5358 N BROADWAY ST
Second Line :
City : CHICAGO
State : IL
Zip : 60640-2312
Country : US
Telephone Number : 312-263-2483
Fax Number :
Authorized Official
Title or Position : PRESIDENT/OWNER
Name : DR. GARY L MONSON
Credential : D.D.S.
Telephone Number : 312-263-2483
Provider Enumeration Date : 05/04/2016
Last Update Date : 04/12/2017

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