Provider Demographics
NPI:1720472228
Name:GALLERY DENTAL OF NAPERVILLE, LTD
Entity Type:Organization
Organization Name:GALLERY DENTAL OF NAPERVILLE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:L
Authorized Official - Last Name:NOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-660-3334
Mailing Address - Street 1:629 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6643
Mailing Address - Country:US
Mailing Address - Phone:630-357-5510
Mailing Address - Fax:
Practice Address - Street 1:629 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6643
Practice Address - Country:US
Practice Address - Phone:630-357-5510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019023437122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty