Active NPI
Rogoberto Ulloa, DDS
- General Practice Dentistry
- Joliet, IL
National Provider Identifier
1114016573
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 19026192
- Practice address
- 500 N Chicago St
Joliet, IL 60432-1706 - Phone
- (815) 724-0500
- Fax
- (815) 724-0583
- NPI assigned
- Oct 12, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 19026192 | IL | Primary |
Addresses
Primary practice location
500 N Chicago St
Joliet, IL 60432-1706
Mailing address
500 N Chicago St
Joliet, IL 60432-1706
Phone (815) 724-0500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19026192 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114016573",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 N CHICAGO ST",
"city": "JOLIET",
"state": "IL",
"postal_code": "604321706",
"telephone_number": "815-724-0500",
"fax_number": "815-724-0583"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 N CHICAGO ST",
"city": "JOLIET",
"state": "IL",
"postal_code": "604321706",
"telephone_number": "815-724-0500",
"fax_number": "815-724-0583"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ULLOA",
"first_name": "ROGOBERTO",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "19026192",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Joliet, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.