Provider Demographics
NPI:1982734257
Name:TRAUL, ROBERT E JR (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:TRAUL
Suffix:JR
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 1:2 SUGARCREEK TRL
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:IL
Mailing Address - Zip Code:61036-9351
Mailing Address - Country:US
Mailing Address - Phone:815-777-3338
Mailing Address - Fax:815-777-3339
Practice Address - Street 1:991 GALENA SQUARE DR
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:IL
Practice Address - Zip Code:61036-1355
Practice Address - Country:US
Practice Address - Phone:815-776-9100
Practice Address - Fax:815-776-7776
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190144221223G0001X
FL113851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9179900Medicaid