MEDICARE: MILAGROS GALVEZ DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019024591	IL

General Provider Information

NPI Number	:	1598996373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILAGROS GALVEZ DDS PC

Provider Business Mailing Address
First Line	:	355 GREENLEAF ST STE E
Second Line	:
City	:	PARK CITY
State	:	IL
Zip	:	60085-5708
Country	:	US
Telephone Number	:	847-249-5700
Fax Number	:	847-249-5714

Provider Business Practice Location Address
First Line	:	355 GREENLEAF ST STE E
Second Line	:
City	:	PARK CITY
State	:	IL
Zip	:	60085-5708
Country	:	US
Telephone Number	:	847-249-5700
Fax Number	:	847-249-5714

Authorized Official
Title or Position	:	DENTIST OWNER
Name	:	DR. MILAGRITOS EDITH CAGHAN
Credential	:	DDS
Telephone Number	:	847-249-5700

Provider Enumeration Date	:	07/28/2009
Last Update Date	:	07/28/2009

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