Excelcare Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019025715 Issued in IL

Legal business name

EXCELCARE DENTAL LLC

Practice address

1227 N State Route 83
E
Grayslake, IL 60030-7932

Phone

(847) 548-2222

Fax

(847) 548-2223

NPI assigned

Apr 23, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Susan Oh, DDSNPI 1306968326

Title

Owner Dentist

Phone

(847) 548-2222

Specialties & licenses 1

Addresses

Locations

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.

• Susan Jiyoung Oh, DDS

  • Dentist
  • Grayslake, IL
  • NPI 1306968326
  NPD (past) Authorized official

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

{
    "created_epoch": "1429747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429747200000",
    "number": "1073900460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1227 N STATE ROUTE 83",
            "address_2": "E",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600307932",
            "telephone_number": "847-548-2222",
            "fax_number": "847-548-2223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1227 N STATE ROUTE 83",
            "address_2": "E",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600307932",
            "telephone_number": "847-548-2222",
            "fax_number": "847-548-2223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCELCARE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-23",
        "last_updated": "2015-04-23",
        "status": "A",
        "authorized_official_last_name": "OH",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "847-548-2222",
        "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": "019025715",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Grayslake, IL
• Providers in Grayslake, 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 Apr 23, 2015; 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.