Organization Active NPI

Abc Dentistry, LTD.

  • Pediatric Dentistry
  • Schaumburg, IL
National Provider Identifier
1043352354
Registry record updated Jun 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
019.021868 Issued in IL
Legal business name
ABC DENTISTRY, LTD.
Practice address
80 W Hillcrest Blvd Ste 212
Schaumburg, IL 60195
Phone
(847) 882-3360
Fax
(847) 882-3383
NPI assigned
Feb 13, 2007
Last updated
Jun 27, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2018

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

Authorized official

Name
Jennifer Ann Reyes
Title
Office Manager
Phone
(847) 882-3360

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 019.021872 IL
Pediatric Dentistry 1223P0221X 019.021868 IL Primary
Pediatric Dentistry 1223P0221X 019.023646 IL
Pediatric Dentistry 1223P0221X 019.026464 IL
Pediatric Dentistry 1223P0221X 019.015237 IL
Pediatric Dentistry 1223P0221X 019.025711 IL

Addresses

Primary practice location

80 W Hillcrest Blvd Ste 212
Schaumburg, IL 60195

Mailing address

80 W Hillcrest Blvd Ste 212
Schaumburg, IL 60195-3111
Phone (847) 882-3360

Other practice location 1

1000 Grand Canyon Pkwy
Suite 103
Hoffman Estates, IL 60194-1705
Phone (847) 882-3360

Other identifiers 1

IdentifierTypeStateIssuer
019.021868MedicaidIL

National Provider Directory

National Provider Directory

Locations

1000 Grand Canyon Pkwy
Ste 103
Hoffman Estates, IL 60169
Phone (847) 882-3360

80 W Hillcrest Blvd
Ste 212
Schaumburg, IL 60195
Phone (847) 636-6767

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530057600000",
    "number": "1043352354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 W HILLCREST BLVD STE 212",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601953111",
            "telephone_number": "847-882-3360",
            "fax_number": "847-882-3383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 W HILLCREST BLVD STE 212",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "60195",
            "telephone_number": "847-882-3360",
            "fax_number": "847-882-3383"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Grand Canyon Pkwy",
            "address_2": "Suite 103",
            "address_purpose": "LOCATION",
            "city": "Hoffman Estates",
            "state": "IL",
            "postal_code": "601941705",
            "country_code": "US",
            "telephone_number": "847-882-3360",
            "fax_number": "847-882-3383",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ABC DENTISTRY, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2018-06-27",
        "status": "A",
        "authorized_official_last_name": "REYES",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "847-882-3360"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.021872",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IL",
            "license": "019.021868",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IL",
            "license": "019.023646",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IL",
            "license": "019.026464",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IL",
            "license": "019.015237",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IL",
            "license": "019.025711",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019.021868",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Schaumburg, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2018; 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.