Healthcare Provider Details

I. General information

NPI: 1750259941
Provider Name (Legal Business Name): CORY GRATHWOL, DMD AND NICOLE GANGE , DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 E OGDEN AVE
NAPERVILLE IL
60563-8560
US

IV. Provider business mailing address

1108 E OGDEN AVE
NAPERVILLE IL
60563-8560
US

V. Phone/Fax

Practice location:
  • Phone: 630-778-9500
  • Fax:
Mailing address:
  • Phone: 630-778-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CHELSEA CORONADO
Title or Position: PRACTICE MANAGER
Credential: RDH
Phone: 630-778-9500