MEDICARE: ROBERT R. GIERING D.D.S. LTD.

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	019016807	IL

General Provider Information

NPI Number	:	1629504808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT R. GIERING D.D.S. LTD.

Provider Business Mailing Address
First Line	:	475 W 55TH ST
Second Line	:	SUITE 205
City	:	COUNTRYSIDE
State	:	IL
Zip	:	60525-3564
Country	:	US
Telephone Number	:	708-354-3409
Fax Number	:

Provider Business Practice Location Address
First Line	:	475 W 55TH ST
Second Line	:	SUITE 205
City	:	COUNTRYSIDE
State	:	IL
Zip	:	60525-3564
Country	:	US
Telephone Number	:	708-354-3409
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT R GIERING
Credential	:	D.D.S.
Telephone Number	:	708-354-3409

Provider Enumeration Date	:	05/05/2017
Last Update Date	:	05/05/2017

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