MEDICARE: DR. GARY J GUNKEL DDS

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		IL

General Provider Information

NPI Number	:	1669521811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY J GUNKEL DDS

Provider Business Mailing Address
First Line	:	14475 JOHN HUMPHREY DR STE 310
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-6218
Country	:	US
Telephone Number	:	708-460-1109
Fax Number	:	708-460-1150

Provider Business Practice Location Address
First Line	:	14475 JOHN HUMPHREY DR STE 310
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-6218
Country	:	US
Telephone Number	:	708-460-1109
Fax Number	:	708-460-1150

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/08/2007

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