Provider Demographics
NPI:1235575739
Name:CYGAN, GREGORY A (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:A
Last Name:CYGAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 W ROOSEVELT RD STE C1
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-2304
Mailing Address - Country:US
Mailing Address - Phone:630-765-7557
Mailing Address - Fax:630-581-9877
Practice Address - Street 1:610 W ROOSEVELT RD STE C1
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-2304
Practice Address - Country:US
Practice Address - Phone:630-765-7557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-12
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012816A122300000X
IL019029409122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist