NPIMap

Organization Active NPI

Endodontic & Periodontic Associates, LTD

  • Endodontics
  • Homewood, IL
National Provider Identifier
1013075480
Registry record updated Oct 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
060000064 Issued in IL
Legal business name
ENDODONTIC & PERIODONTIC ASSOCIATES, LTD
Practice address
18130 Halsted St
Homewood, IL 60430-2507
Phone
(708) 799-2550
Fax
(708) 799-2568
NPI assigned
Dec 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. J. Michael Cvengros
Title
Coo & Practice Administrator
Phone
(708) 922-1165

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
EndodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223E0200X 060000064 IL Primary
PeriodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0300X 060000064 IL

Addresses

Primary practice location

18130 Halsted St
Homewood, IL 60430-2507

Mailing address

18130 Halsted St
Homewood, IL 60430-2507
Phone (708) 799-2550

National Provider Directory

National Provider Directory

Locations

18130 Halsted St
Homewood, IL 60430
Phone (708) 799-2550

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413504000000",
    "number": "1013075480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18130 HALSTED ST",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "604302507",
            "telephone_number": "708-799-2550",
            "fax_number": "708-799-2568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18130 HALSTED ST",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "604302507",
            "telephone_number": "708-799-2550",
            "fax_number": "708-799-2568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENDODONTIC & PERIODONTIC ASSOCIATES, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2014-10-17",
        "status": "A",
        "authorized_official_last_name": "CVENGROS",
        "authorized_official_first_name": "J. MICHAEL",
        "authorized_official_title_or_position": "COO & PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "708-922-1165",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": "IL",
            "license": "060000064",
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": "060000064",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Homewood, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.