Provider Demographics
NPI:1457372864
Name:TODD, GARY STEPHEN (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:STEPHEN
Last Name:TODD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 E CENTRAL RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-3245
Mailing Address - Country:US
Mailing Address - Phone:847-253-1300
Mailing Address - Fax:847-253-1305
Practice Address - Street 1:1130 E CENTRAL RD
Practice Address - Street 2:SUITE A
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-3245
Practice Address - Country:US
Practice Address - Phone:847-253-1300
Practice Address - Fax:847-253-1305
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19015252122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist