Individual provider Active NPI

Tylor Lawrence Gauger, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Palos Heights, IL
National Provider Identifier
1013445105
Registry record updated Jun 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
019.033052 Issued in IL
Practice address
7400 W College Dr
Palos Heights, IL 60463-1155
Phone
(708) 448-8670
Fax
(708) 448-8698
NPI assigned
Jun 1, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 019.033052 IL Primary

Addresses

Primary practice location

7400 W College Dr
Palos Heights, IL 60463-1155

Mailing address

1247 W Madison St Unit 305
Chicago, IL 60607-0800
Phone (765) 860-7794

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170607000399 IN Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 6901173384

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019.033052ILMDOral and Maxillofacial Surgery (Dentist)

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Oral and Maxillofacial Surgery Oral and Maxillofacial Surgery PastSince Jun 23, 2024 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1496275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718841600000",
    "number": "1013445105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1247 W MADISON ST UNIT 305",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606070800",
            "telephone_number": "765-860-7794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7400 W COLLEGE DR",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604631155",
            "telephone_number": "708-448-8670",
            "fax_number": "708-448-8698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAUGER",
        "first_name": "TYLOR",
        "middle_name": "LAWRENCE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-01",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "019.033052",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palos Heights, IL

Sources for this page

Verify at the official NPI Registry.