Provider Demographics
NPI:1811234396
Name:GAULE, JEFFREY I (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:I
Last Name:GAULE
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 1:1105 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3312
Mailing Address - Country:US
Mailing Address - Phone:773-281-7550
Mailing Address - Fax:773-281-0808
Practice Address - Street 1:1105 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3312
Practice Address - Country:US
Practice Address - Phone:773-281-7550
Practice Address - Fax:773-281-0808
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0174541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice