Healthcare Provider Details

I. General information

NPI: 1831663293
Provider Name (Legal Business Name): DENTISTRY BY DGI, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6737 KINGERY HWY
WILLOWBROOK IL
60527-5142
US

IV. Provider business mailing address

4950 N LEAVITT ST
CHICAGO IL
60625-1309
US

V. Phone/Fax

Practice location:
  • Phone: 630-570-5555
  • Fax:
Mailing address:
  • Phone: 773-218-7653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID GERARD INGALLINERA
Title or Position: PRESIDENT
Credential: DDS
Phone: 773-218-7653