Jerry Udelson, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

021-001495 Issued in IL

Practice address

1125 Harlem Ave
Forest Park, IL 60130-2337

Phone

(708) 386-5437

Fax

(708) 771-5439

NPI assigned

Apr 19, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jerry E Udelson, DDS, PC

  dba Little Teeth Big Smiles & Children's Dentistry

  • Pediatric Dentistry
  • Forest Park, IL
  • NPI 1881885127
  NPD Authorized official
• Udelson Elmhurst LLC

  dba Elmhurst Dentistry for Kids

  • Dental Clinic/Center
  • Elmhurst, IL
  • NPI 1245741768
  NPD Authorized official
• Big Smiles Center for Orthodontic Excellence LLC

  • Health Maintenance Organization
  • Riverside, IL
  • NPI 1689009797
  Authorized official Same address or phone

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1013134154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 HARLEM AVE",
            "city": "FOREST PARK",
            "state": "IL",
            "postal_code": "601302337",
            "telephone_number": "708-386-5437",
            "fax_number": "708-771-5439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 HARLEM AVE",
            "city": "FOREST PARK",
            "state": "IL",
            "postal_code": "601302337",
            "telephone_number": "708-386-5437",
            "fax_number": "708-771-5439"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "323 N York St",
            "address_purpose": "LOCATION",
            "city": "Elmhurst",
            "state": "IL",
            "postal_code": "601262319",
            "country_code": "US",
            "telephone_number": "630-833-1166",
            "fax_number": "630-833-1103",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "UDELSON",
        "first_name": "JERRY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-19",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IL",
            "license": "021-001495",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rigoberto Tapia, MD
• Teeth and Things PLLC
• Ciara Valise Thomas, LCSW
• John Esteban Towers
• Chloe Tully, LCPC
• Kara Unatin
• Untangle Counseling PLLC
• Heather Rene Urban, MSOT, OTR/L
• Aviana Lys Valdez
• Stephanie Lizbeth Valdez

• Pediatric Dentistry in Forest Park, IL
• Providers in Forest Park, IL by specialty
• Pediatric Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; 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.