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General NPI Number Information
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NPI Number | 1609548064
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Entity Type | Organization
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Legal Business Name | GALLEGOS DENTAL, PLLC
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Dates
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Enumeration Date | 10/04/2021
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 152 N ADDISON AVE STE 201
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City | ELMHURST
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State | IL
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Zip | 60126-2821
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Country | US
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Telephone | 630-530-8852
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Fax |
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Provider Business Mailing Address
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Address Line | 15857 SPANGLERS FARM DR
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City | PLAINFIELD
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State | IL
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Zip | 60544-2160
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Country | US
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Telephone | 815-274-0198
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. EVAN ROBERT GALLEGOS
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Credential | DMD
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Telephone | 815-274-0198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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