NPIMap

Organization Active NPI

Graceland Prairie Dental

  • General Practice Dentistry
  • Des Plaines, IL
National Provider Identifier
1134494727
Registry record updated Mar 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019017115 Issued in IL
Legal business name
GRACELAND PRAIRIE DENTAL
Practice address
685 Graceland Ave
Des Plaines, IL 60016-4518
Phone
(847) 824-3536
Fax
(847) 824-2783
NPI assigned
Mar 14, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2012

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

Authorized official

Name
Dr. Joseph P Barry, D.D.S.NPI 1598751950
Title
Owner
Phone
(847) 824-3536

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 019017115 IL Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 019020748 IL

Addresses

Primary practice location

685 Graceland Ave
Des Plaines, IL 60016-4518

Mailing address

685 Graceland Ave
Des Plaines, IL 60016-4518
Phone (847) 824-3536

National Provider Directory

National Provider Directory

Locations

685 Graceland Ave
Des Plaines, IL 60016
Phone (847) 824-3536

Practitioners & affiliated clinicians

Practitioners 3

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": "1331683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331683200000",
    "number": "1134494727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "685 GRACELAND AVE",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600164518",
            "telephone_number": "847-824-3536",
            "fax_number": "847-824-2783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "685 GRACELAND AVE",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600164518",
            "telephone_number": "847-824-3536",
            "fax_number": "847-824-2783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACELAND PRAIRIE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-14",
        "last_updated": "2012-03-14",
        "status": "A",
        "authorized_official_last_name": "BARRY",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-824-3536",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019017115",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019020748",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Plaines, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2012; 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.