Healthcare Provider Details

I. General information

NPI: 1366552408
Provider Name (Legal Business Name): GREGORY PAUL SCHUBERT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7756 ARCHER RD
JUSTICE IL
60458-1146
US

IV. Provider business mailing address

7756 ARCHER RD
JUSTICE IL
60458-1146
US

V. Phone/Fax

Practice location:
  • Phone: 708-594-2848
  • Fax: 708-594-3459
Mailing address:
  • Phone: 708-594-2848
  • Fax: 708-594-3459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019019301
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: