Dubravec Periodontal Associates, PC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

019021633 Issued in IL

Legal business name

DUBRAVEC PERIODONTAL ASSOCIATES, PC

Practice address

1900 Spring Rd
Suite 205
Oak Brook, IL 60523-1447

Phone

(630) 573-0369

Fax

(630) 573-0234

NPI assigned

Oct 8, 2015

Last updated

Oct 8, 2015By 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

Dominik B. Dubravec, DDS, MMSC

Title

Owner

Phone

(815) 464-3001

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1444262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444262400000",
    "number": "1114398831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20635 ABBEY WOODS CT N",
            "address_2": "SUITE 203",
            "city": "FRANKFORT",
            "state": "IL",
            "postal_code": "604233181",
            "telephone_number": "815-464-3001",
            "fax_number": "815-464-3010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 SPRING RD",
            "address_2": "SUITE 205",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231447",
            "telephone_number": "630-573-0369",
            "fax_number": "630-573-0234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUBRAVEC PERIODONTAL ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-08",
        "last_updated": "2015-10-08",
        "status": "A",
        "authorized_official_last_name": "DUBRAVEC",
        "authorized_official_first_name": "DOMINIK",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-464-3001",
        "authorized_official_credential": "DDS, MMSC"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": "019021633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Oak Brook, IL
• Providers in Oak Brook, IL by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 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.