Provider Demographics
NPI:1013363498
Name:GARY L. MONSON, D.D.S., P.C.
Entity type:Organization
Organization Name:GARY L. MONSON, D.D.S., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MONSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-263-2483
Mailing Address - Street 1:5358 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2312
Mailing Address - Country:US
Mailing Address - Phone:312-263-2483
Mailing Address - Fax:
Practice Address - Street 1:5358 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2312
Practice Address - Country:US
Practice Address - Phone:312-263-2483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190192361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty