Provider Demographics
NPI:1619139417
Name:GARY S MEYERS DDS PC
Entity Type:Organization
Organization Name:GARY S MEYERS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-432-0254
Mailing Address - Street 1:1770 1ST ST
Mailing Address - Street 2:SUITE 450
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3200
Mailing Address - Country:US
Mailing Address - Phone:847-432-0254
Mailing Address - Fax:847-432-2848
Practice Address - Street 1:1770 FIRST ST
Practice Address - Street 2:SUITE 450
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3200
Practice Address - Country:US
Practice Address - Phone:847-432-0254
Practice Address - Fax:847-432-2848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty