Sauk Trail Dental Care

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SAUK TRAIL DENTAL CARE

Practice address

4343 Sauk TRL
Richton Park, IL 60471-1254

Phone

(708) 608-3368

NPI assigned

Mar 4, 2021

Last updated

May 25, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Lawal Garuba, DMDNPI 1013431543

Title

Dentist

Phone

(708) 608-3368

Specialties & licenses 2

Addresses

Practitioners 1

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.

• Lawal Garuba, DMD

  • General Practice Dentistry
  • Chicago, IL
  • NPI 1013431543
  NPD (past) Authorized official

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

{
    "created_epoch": "1614816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621900800000",
    "number": "1073108841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4343 SAUK TRL",
            "city": "RICHTON PARK",
            "state": "IL",
            "postal_code": "604711254",
            "telephone_number": "708-608-3368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4343 SAUK TRL",
            "city": "RICHTON PARK",
            "state": "IL",
            "postal_code": "604711254",
            "telephone_number": "708-608-3368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAUK TRAIL DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-04",
        "last_updated": "2021-05-25",
        "certification_date": "2021-05-25",
        "status": "A",
        "authorized_official_last_name": "GARUBA",
        "authorized_official_first_name": "LAWAL",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "708-608-3368",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Richton Park, IL
• Providers in Richton Park, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2021; 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.