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General NPI Number Information
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NPI Number | 1730288242
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Entity Type | Organization
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Legal Business Name | GATEWAY DENTAL CENTRE, P.C.
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 02/28/2008
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Provider Practice Location Address
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Address Line | 534 MAIN ST
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City | WEST CHICAGO
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State | IL
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Zip | 60185-2843
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Country | US
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Telephone | 630-876-9200
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Fax | 630-876-9201
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Provider Business Mailing Address
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Address Line | 534 MAIN ST
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City | WEST CHICAGO
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State | IL
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Zip | 60185-2843
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Country | US
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Telephone | 630-876-9200
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Fax | 630-876-9201
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Authorized Official
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Title or Position | PRESIDENT / DENTIST
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Name | MRS. DENA SPENCER
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Credential | D.D.S.
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Telephone | 630-876-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State | IL
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