NPIMap

Organization Active NPI

Heritage Grove Family Dental P.C.

  • General Practice Dentistry
  • Plainfield, IL
National Provider Identifier
1013336445
Registry record updated Apr 14, 2014
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Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019025501 Issued in IL
Legal business name
HERITAGE GROVE FAMILY DENTAL P.C.
Practice address
12426 S Van Dyke Rd
Unit B
Plainfield, IL 60585-2700
Phone
(815) 254-1375
NPI assigned
Apr 14, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2014

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

Authorized official

Name
Dr. Pete A Gallos, DDS
Title
Dentist
Phone
(815) 254-1375

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 019025501 IL Primary

Addresses

Primary practice location

12426 S Van Dyke Rd
Unit B
Plainfield, IL 60585-2700

Mailing address

12426 S Van Dyke Rd
Unit B
Plainfield, IL 60585-2700

National Provider Directory

National Provider Directory

Locations

12426 S Van Dyke Rd
Unit B
Plainfield, IL 60585
Phone (815) 254-1375

NPI Registry JSON

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

{
    "created_epoch": "1397433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397433600000",
    "number": "1013336445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12426 S VAN DYKE RD",
            "address_2": "UNIT B",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605852700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12426 S VAN DYKE RD",
            "address_2": "UNIT B",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605852700",
            "telephone_number": "815-254-1375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE GROVE FAMILY DENTAL P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-14",
        "last_updated": "2014-04-14",
        "status": "A",
        "authorized_official_last_name": "GALLOS",
        "authorized_official_first_name": "PETE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "815-254-1375",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019025501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plainfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 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.