Provider Demographics
NPI:1740426188
Name:GAITROS DENTAL CENTER
Entity Type:Organization
Organization Name:GAITROS DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:OAKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-875-5020
Mailing Address - Street 1:1080 E MOUND RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-9385
Mailing Address - Country:US
Mailing Address - Phone:217-875-5020
Mailing Address - Fax:217-875-0235
Practice Address - Street 1:1080 E MOUND RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-9385
Practice Address - Country:US
Practice Address - Phone:218-750-5020
Practice Address - Fax:217-875-0235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty