Provider Demographics
NPI:1053582932
Name:WEGMANN, GARY G (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:G
Last Name:WEGMANN
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 1:55 E WASHINGTON ST
Mailing Address - Street 2:SUITE 3601
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-2103
Mailing Address - Country:US
Mailing Address - Phone:312-551-0500
Mailing Address - Fax:
Practice Address - Street 1:55 E WASHINGTON ST
Practice Address - Street 2:SUITE 3601
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2103
Practice Address - Country:US
Practice Address - Phone:312-551-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist