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General NPI Number Information
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NPI Number | 1457897332
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Entity Type | Organization
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Legal Business Name | MARIA THERESE GALANG DMD MS P C
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Dates
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Enumeration Date | 01/16/2017
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 30 N MICHIGAN AVE STE 622
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City | CHICAGO
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State | IL
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Zip | 60602-3821
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Country | US
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Telephone | 773-609-4446
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Fax |
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Provider Business Mailing Address
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Address Line | 222 E PEARSON ST #1402
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City | CHICAGO
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State | IL
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Zip | 60611-7347
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARIA THERESE GALANG
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Credential | DMD MS
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Telephone | 312-450-2434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 019027449
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License Number State | IL
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