Active NPI
Polly Clare Gallavin, DMD
- General Practice Dentistry
- Darien, IL
National Provider Identifier
1740703669
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019.031273
- Practice address
- 6700 Rte 83
Darien, IL 60561-3972 - Phone
- (630) 789-0900
- NPI assigned
- Jul 23, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019.031273 | IL | Primary |
Addresses
Primary practice location
6700 Rte 83
Darien, IL 60561-3972
Mailing address
1568 Clyde Dr
Naperville, IL 60565-1308
Phone (630) 200-3085
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.031273 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1500768000000",
"number": "1740703669",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1568 CLYDE DR",
"city": "NAPERVILLE",
"state": "IL",
"postal_code": "605651308",
"telephone_number": "630-200-3085"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6700 RTE 83",
"city": "DARIEN",
"state": "IL",
"postal_code": "605613972",
"telephone_number": "630-789-0900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GALLAVIN",
"first_name": "POLLY",
"middle_name": "CLARE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-07-23",
"last_updated": "2017-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019.031273",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Darien, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.