Provider Demographics
NPI:1437228459
Name:GAROFALO, GARY STEPHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:STEPHEN
Last Name:GAROFALO
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 1:8825 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-1008
Mailing Address - Country:US
Mailing Address - Phone:708-599-0500
Mailing Address - Fax:708-599-0501
Practice Address - Street 1:8825 W 95TH ST
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1008
Practice Address - Country:US
Practice Address - Phone:708-599-0500
Practice Address - Fax:708-599-0501
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A155441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice