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General NPI Number Information
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NPI Number | 1639665359
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Entity Type | Organization
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Legal Business Name | GATEWAY DENTAL GROUP OF ILLINOIS LLC
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Dates
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Enumeration Date | 07/05/2018
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Last Update Date | 07/06/2018
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Provider Practice Location Address
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Address Line | 93 CRESTMOOR
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City | COLLINSVILLE
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State | IL
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Zip | 62234
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Country | US
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Telephone | 314-518-1088
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Fax |
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Provider Business Mailing Address
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Address Line | 4905 STONE FALLS CENTER
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City | O'FALLON
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State | IL
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Zip | 62269
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Country | US
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Telephone | 314-518-1088
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. REBECCA F SCHREINER
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Credential | DDS
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Telephone | 314-518-1088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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