Provider Demographics
NPI:1710233077
Name:GARGIULO & GARGIULO LTD
Entity Type:Organization
Organization Name:GARGIULO & GARGIULO LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARGIULO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-236-8514
Mailing Address - Street 1:30 N MICHIGAN AVE
Mailing Address - Street 2:#1904
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3402
Mailing Address - Country:US
Mailing Address - Phone:312-236-8514
Mailing Address - Fax:312-372-1743
Practice Address - Street 1:30 N MICHIGAN AVE
Practice Address - Street 2:#1904
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3402
Practice Address - Country:US
Practice Address - Phone:312-236-8514
Practice Address - Fax:312-372-1743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty