NPIMap

Organization Active NPI

New Age Dental Holdings, LTD

Doing business as New Age Dental

  • General Practice Dentistry
  • Morton Grove, IL
National Provider Identifier
1144762709
Registry record updated Nov 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019021632 Issued in IL
Legal business name
NEW AGE DENTAL HOLDINGS, LTD
Doing business as
New Age Dental
Practice address
8930 Waukegan Rd
Suite 110
Morton Grove, IL 60053-2126
Phone
(847) 967-0400
NPI assigned
Nov 14, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2016

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

Authorized official

Name
Dr. Glenn Shulkin, DDSNPI 1023138732
Title
President
Phone
(847) 301-0400

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
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 019021632 IL Primary

Addresses

Primary practice location

8930 Waukegan Rd
Suite 110
Morton Grove, IL 60053-2126

Mailing address

1061 S Roselle Rd
Schaumburg, IL 60193-3960
Phone (847) 301-0400

Other names 1

  • New Age Dental Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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": "1479081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479081600000",
    "number": "1144762709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1061 S ROSELLE RD",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601933960",
            "telephone_number": "847-301-0400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8930 WAUKEGAN RD",
            "address_2": "SUITE 110",
            "city": "MORTON GROVE",
            "state": "IL",
            "postal_code": "600532126",
            "telephone_number": "847-967-0400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW AGE DENTAL HOLDINGS, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-14",
        "last_updated": "2016-11-14",
        "status": "A",
        "authorized_official_last_name": "SHULKIN",
        "authorized_official_first_name": "GLENN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-301-0400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019021632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Age Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Morton Grove, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2016; 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.