NPIMap

Organization Active NPI

Elmhurst Dental Group, LTD

Doing business as Addison Dental

  • Oral and Maxillofacial Surgery (Dentist)
  • Addison, IL
National Provider Identifier
1073954723
Registry record updated Jul 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
019014858 Issued in IL
Legal business name
ELMHURST DENTAL GROUP, LTD
Doing business as
Addison Dental
Practice address
1201 W Army Trail Blvd
Suite 2
Addison, IL 60101-3152
Phone
(630) 543-8688
Fax
(630) 543-8692
NPI assigned
Jul 10, 2013
Last updated
Jul 10, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2013

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

Authorized official

Name
Dr. Lawrence Groh, DDSNPI 1639236334
Title
Owner/President
Phone
(630) 833-5110

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X 019014858 IL Primary

Addresses

Primary practice location

1201 W Army Trail Blvd
Suite 2
Addison, IL 60101-3152

Mailing address

333 W 1St St
Elmhurst, IL 60126-2641
Phone (630) 833-5110

Other names 1

  • Addison Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Elmhurst Dental Group LTD Dba St Charles Dental7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1201 W Army Trail Blvd
Ste 2
Addison, IL 60101
Phone (630) 543-8688

Practitioners & affiliated clinicians

Practitioners 2

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": "1373414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373414400000",
    "number": "1073954723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 W 1ST ST",
            "city": "ELMHURST",
            "state": "IL",
            "postal_code": "601262641",
            "telephone_number": "630-833-5110",
            "fax_number": "630-833-0458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 W ARMY TRAIL BLVD",
            "address_2": "SUITE 2",
            "city": "ADDISON",
            "state": "IL",
            "postal_code": "601013152",
            "telephone_number": "630-543-8688",
            "fax_number": "630-543-8692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELMHURST DENTAL GROUP, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-10",
        "last_updated": "2013-07-10",
        "status": "A",
        "authorized_official_last_name": "GROH",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "630-833-5110",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "019014858",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Addison Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Addison, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2013; 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.