Provider Demographics
NPI:1851897268
Name:MEREDITH GANTOS DDS LLC
Entity Type:Organization
Organization Name:MEREDITH GANTOS DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-420-9090
Mailing Address - Street 1:8 W GARTNER RD STE 168
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-7547
Mailing Address - Country:US
Mailing Address - Phone:630-420-9090
Mailing Address - Fax:630-420-8081
Practice Address - Street 1:8 W. GARTNER ROAD
Practice Address - Street 2:168
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-7547
Practice Address - Country:US
Practice Address - Phone:630-420-9090
Practice Address - Fax:630-420-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0297921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty