| The Tooth Repair Shoppe, Ltd. | |
|
610 W Roosevelt Rd Suite A1 Wheaton IL 60187-5087 | |
| (630) 682-0844 | |
| (630) 682-1428 |
| Full Name | The Tooth Repair Shoppe, Ltd. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 610 W Roosevelt Rd, Wheaton, Illinois |
| Authorized Official Name and Position | Gregory C. Calleia (DENTIST) |
| Authorized Official Contact | 6306820844 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Tooth Repair Shoppe, Ltd. 610 W. Roosevelt Road Suite A1 Wheaton IL 60187 Ph: (630) 682-0844 | The Tooth Repair Shoppe, Ltd. 610 W Roosevelt Rd Suite A1 Wheaton IL 60187-5087 Ph: (630) 682-0844 |
| NPI Number | 1669529145 |
|---|---|
| Provider Enumeration Date | 01/05/2007 |
| Last Update Date | 06/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669529145 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 060008257 (Illinois) | Primary |
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