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General NPI Number Information
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NPI Number | 1588465702
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Entity Type | Individual
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Provider Name | SAMANTHA E GILLOOLEY DDS
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Gender | Female
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 2160 S 1ST AVE
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City | MAYWOOD
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State | IL
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Zip | 60153-3328
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Country | US
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Telephone | 888-584-7888
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Fax |
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Provider Business Mailing Address
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Address Line | 12340 W BENTWOOD DR
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City | HOMER GLEN
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State | IL
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Zip | 60491-6971
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Country | US
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Telephone | 708-927-3959
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.036108
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License Number State | IL
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