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NPI Code Detail

MEDICARE: DR. GARY ALLEN HOSTERS D.D.S

MEDICARE: DR. GARY ALLEN HOSTERS 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
11223P0300XPeriodonticsIL

General Provider Information

NPI Number : 1841401312
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY ALLEN HOSTERS D.D.S
Provider Business Mailing Address
First Line : 5400 N MILWAUKEE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60630-1272
Country : US
Telephone Number : 773-774-4888
Fax Number : 773-774-4988
Provider Business Practice Location Address
First Line : 5400 N MILWAUKEE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60630-1272
Country : US
Telephone Number : 773-774-4888
Fax Number : 773-774-4988
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2007
Last Update Date : 07/08/2007

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