Healthcare Provider Details

I. General information

NPI: 1538574546
Provider Name (Legal Business Name): MEREDITH GANTOS DDS, FAGD.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 N WASHINGTON ST STE 106
NAPERVILLE IL
60563-3462
US

IV. Provider business mailing address

720 N WASHINGTON ST STE 106
NAPERVILLE IL
60563-3462
US

V. Phone/Fax

Practice location:
  • Phone: 630-420-9090
  • Fax: 630-420-8081
Mailing address:
  • Phone: 630-420-9090
  • Fax: 630-420-8081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.029792
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.029792
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: