Provider Demographics
NPI:1124212253
Name:ALBERTS, GARY G (GARY ALBERTS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:G
Last Name:ALBERTS
Suffix:
Gender:M
Credentials:GARY ALBERTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 SUNSET RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4006
Mailing Address - Country:US
Mailing Address - Phone:847-272-7874
Mailing Address - Fax:847-272-9566
Practice Address - Street 1:821 SUNSET RIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4006
Practice Address - Country:US
Practice Address - Phone:847-272-7874
Practice Address - Fax:847-272-9566
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-019-20081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice