The Tooth Repair Shoppe, Ltd.

NPI #1669529145 in Wheaton, Illinois

Provider Information

NPI Number: 1669529145
Entity Type: Organization
Organization Name: The Tooth Repair Shoppe, Ltd.
Primary Specialty: Dentist - General Practice
Enumeration Date: Jan 5, 2007
Last Updated: Jun 20, 2008

Practice Location

Address: 610 W ROOSEVELT RD
Address 2: SUITE A1
City: Wheaton
State: Illinois
ZIP Code: 60187-5087
Phone: (630) 682-0844

Authorized Official

Name: DR. GREGORY C. CALLEIA, DDS
Title: DENTIST
Phone: (630) 682-0844

Specialties & Taxonomy Codes

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

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