Organization
GATEWAY DENTAL GROUP, LLC
Active
Other names
Troy Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD R BOATMAN JR. DMD (MANAGER)
(618) 667-8070
Entity
Organization
Contact information
Practice address
606 EDWARDSVILLE ROAD, TROY, IL 62294
(618) 667-8020
(618) 667-8078
Mailing address
606 EDWARDSVILLE ROAD, TROY, IL 62294
(618) 667-8020
(618) 667-8078
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
19-020938
IL
1223G0001X
General Practice Dentistry
19-025636
IL
Other
Enumeration date
10/27/2016
Last updated
10/27/2016
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