NPIMap

Organization Active NPI

Dental Professionals of Illinois, P.C.

Doing business as Complete Dental of Frankfort

  • General Practice Dentistry
  • Frankfort, IL
National Provider Identifier
1134624307
Registry record updated Mar 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
DENTAL PROFESSIONALS OF ILLINOIS, P.C.
Doing business as
Complete Dental of Frankfort
Practice address
590 Bankview Dr Ste a
Frankfort, IL 60423-1858
Phone
(815) 469-3373
NPI assigned
Mar 28, 2018
Organization subpart
Yes
Parent organization
DENTAL PROFESSIONALS OF ILLINOIS, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 28, 2018

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

Authorized official

Name
Cassandra Petersen
Title
Credentialing Team Lead
Phone
(217) 540-8972

Specialties & licenses 1

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

Addresses

Primary practice location

590 Bankview Dr Ste a
Frankfort, IL 60423-1858

Mailing address

590 Bankview Dr Ste a
Frankfort, IL 60423-1858
Phone (815) 469-3373

Other names 1

  • Complete Dental of Frankfort Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dental Professionals of Illinois PC75 organizations share this tax ID, including this one
Part of
Dental Professionals of Illinois PC

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1522195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522195200000",
    "number": "1134624307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "590 BANKVIEW DR STE A",
            "city": "FRANKFORT",
            "state": "IL",
            "postal_code": "604231858",
            "telephone_number": "815-469-3373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 BANKVIEW DR STE A",
            "city": "FRANKFORT",
            "state": "IL",
            "postal_code": "604231858",
            "telephone_number": "815-469-3373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PROFESSIONALS OF ILLINOIS, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL PROFESSIONALS OF ILLINOIS, P.C.",
        "enumeration_date": "2018-03-28",
        "last_updated": "2018-03-28",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "CASSANDRA",
        "authorized_official_title_or_position": "CREDENTIALING TEAM LEAD",
        "authorized_official_telephone_number": "217-540-8972"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Complete Dental of Frankfort",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Frankfort, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2018; 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.