Provider Demographics
NPI:1801052840
Name:JEFFREY GAULE DDS LTD
Entity type:Organization
Organization Name:JEFFREY GAULE DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:I
Authorized Official - Last Name:GAULE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-281-7550
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190174541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty