MEDICARE: GATES DENTAL CARE 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	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	019014756	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	33060	OTHER	IL	BLUE SHIELD OF ILLINOIS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962449850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GATES DENTAL CARE PC

Provider Business Mailing Address
First Line	:	8135 N MILWAUKEE AVE
Second Line	:
City	:	NILES
State	:	IL
Zip	:	60714-2828
Country	:	US
Telephone Number	:	847-967-1149
Fax Number	:	847-967-8594

Provider Business Practice Location Address
First Line	:	302 E SAINT CHARLES RD
Second Line	:
City	:	VILLA PARK
State	:	IL
Zip	:	60181-2420
Country	:	US
Telephone Number	:	630-836-4410
Fax Number	:	630-563-9174

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GAMAL S. NAGUIB
Credential	:	DMD
Telephone Number	:	847-967-1149

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	07/21/2022

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Directions to “GATES DENTAL CARE PC ” Practice Location

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