Gateway Dental Group, LLC

NPI #1437601283 in Troy, Illinois

Provider Information

NPI Number: 1437601283
Entity Type: Organization
Organization Name: Gateway Dental Group, LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Oct 27, 2016
Last Updated: Oct 27, 2016

Practice Location

Address: 606 EDWARDSVILLE ROAD
City: Troy
State: Illinois
ZIP Code: 62294
Phone: (618) 667-8020

Authorized Official

Name: DR. RICHARD R BOATMAN JR., DMD
Title: MANAGER
Phone: (618) 667-8070

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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