NPIMap

Organization Active NPI

Lagrange Park Dentistry PC

  • Dental Clinic/Center
  • La Grange Park, IL
National Provider Identifier
1114803822
Registry record updated Aug 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
LAGRANGE PARK DENTISTRY PC
Practice address
360 Sherwood Rd
La Grange Park, IL 60526-1967
Phone
(708) 354-7363
NPI assigned
Aug 15, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2025

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

Authorized official

Name
Dr. Ryan Peterson, DMDNPI 1841676764
Title
President/Owner
Phone
(708) 846-3436

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

360 Sherwood Rd
La Grange Park, IL 60526-1967

Mailing address

5924 Tyler Dr
Woodridge, IL 60517-1007
Phone (708) 846-3436

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1755216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755216000000",
    "number": "1114803822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5924 TYLER DR",
            "city": "WOODRIDGE",
            "state": "IL",
            "postal_code": "605171007",
            "telephone_number": "708-846-3436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 SHERWOOD RD",
            "city": "LA GRANGE PARK",
            "state": "IL",
            "postal_code": "605261967",
            "telephone_number": "708-354-7363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAGRANGE PARK DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-15",
        "last_updated": "2025-08-15",
        "certification_date": "2025-08-15",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "708-846-3436",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Grange Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2025; 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.