Galleria Dental
Organization Active NPI General Practice Dentistry · Mundelein, IL
NPI 1124428099 · NPPES record last updated Dec 10, 2020
Key facts
- NPI
- 1124428099
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Dentistry 1223G0001X
- Legal business name
- GALLERIA DENTAL
- Practice address
- 1535 S Lake St
Mundelein, IL 60060-4210 - Phone
- (847) 566-1900
- Fax
- (847) 566-1904
- NPI assigned
- Aug 28, 2014
- Organization subpart
- Yes
- Parent organization (as reported)
- ASHTON DENTAL PC
Authorized official
- Name
- Sohail S Shafi
- Title
- Manager
- Phone
- (630) 842-3705
Corporate family (same tax ID) 10
Practitioners 2
-
Munir Gomaa, DMD
National Provider Directory
- Tax ID family
- Smile Town Dental
- Part of
- Smile Town Dental
Locations
1535 S Lake St
Mundelein, IL 60060
Phone (847) 566-1900
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry |
1223G0001X | Yes |
Addresses
Primary practice location
1535 S Lake St
Mundelein, IL 60060-4210
Mailing address
1730 Park St Ste 106
Naperville, IL 60563-2609
Phone (847) 566-1900
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All providers in Mundelein, IL · General Practice Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 10, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.