Healthcare Provider Details

I. General information

NPI: 1336319177
Provider Name (Legal Business Name): MARIA THERESE SABATER GALANG D.M.D., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S PAULINA ST DEPT. OF ORTHODONTICS RM. 131
CHICAGO IL
60612-7210
US

IV. Provider business mailing address

801 S PAULINA ST DEPT. OF ORTHODONTICS RM. 131
CHICAGO IL
60612-7210
US

V. Phone/Fax

Practice location:
  • Phone: 312-413-3022
  • Fax:
Mailing address:
  • Phone: 312-413-3022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019-027449
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number021002241, 019027449
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: