MEDICARE: DR. THERON LAYER D.D.S.

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
1	1223G0001X	General Practice Dentistry	019030826	IL

General Provider Information

NPI Number	:	1386093755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERON LAYER D.D.S.

Provider Business Mailing Address
First Line	:	4300 PALMER DR
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-5661
Country	:	US
Telephone Number	:	319-671-1233
Fax Number	:

Provider Business Practice Location Address
First Line	:	10065 W LINCOLN HWY
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-1272
Country	:	US
Telephone Number	:	319-671-1233
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2016
Last Update Date	:	12/11/2025

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