Provider Demographics
NPI:1881008472
Name:GALLARDI, ROBIN LEE (BSC DDS MSC FRCD(C))
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LEE
Last Name:GALLARDI
Suffix:
Gender:F
Credentials:BSC DDS MSC FRCD(C)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 GROSVENOR STREET APT 1607
Mailing Address - Street 2:ONTARIO CANADA M4Y 3G5
Mailing Address - City:TORONTO
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:M4Y 3G5
Mailing Address - Country:CA
Mailing Address - Phone:416-877-1231
Mailing Address - Fax:
Practice Address - Street 1:15300 WEST AVE
Practice Address - Street 2:SUITE 113
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4600
Practice Address - Country:US
Practice Address - Phone:708-348-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019029722122300000X
IL0210025711223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist