Edp of Illinois P.C

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

EDP OF ILLINOIS P.C

Doing business as

Affordable Dental of Illnois

Practice address

195 S Main St
Dupo, IL 62239-1347

Phone

(312) 800-1270

NPI assigned

Feb 18, 2015

Last updated

Sep 29, 2021By 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

Melissa Garibay

Title

Credentialing Manager

Phone

(312) 736-8963

Specialties & licenses 2

Addresses

Other names 1

• Affordable Dental of Illnois Doing business as

Tax ID family

Elite Dental Partners LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Elite Dental Partners, LLC

  dba James S Kakos, DDS

  • Dental Clinic/Center
  • Arlington Heights, IL
  • NPI 1700345410
  NPD tax ID

Locations

Practitioners 47

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gilbert Abadilla, DDS

  • Dentist
  • Bloomingdale, IL
  • NPI 1710003686
  NPD (past)
• Ameenuddin Syed Ahmed

  • Dentist
  • Bloomingdale, IL
  • NPI 1689304602
  NPD (past)
• Paul M Anfenson, D.D.S.

  • General Practice Dentistry
  • Arlington Heights, IL
  • NPI 1114967262
  NPD (past)
• Peter S Baek, D.D.S.

  • Dentist
  • Arlington Heights, IL
  • NPI 1821123761
  NPD (past)
• Ravi Mahesh Barot, DMD

  • General Practice Dentistry
  • Arlington Heights, IL
  • NPI 1093361073
  NPD (past)
• Mark D. Beck, D.D.S.

  • General Practice Dentistry
  • Glen Ellyn, IL
  • NPI 1730118456
  NPD (past)
• Michael Bentley, DDS

  • General Practice Dentistry
  • Creve Coeur, IL
  • NPI 1194883389
  NPD (past)
• Vikas Beri, DMD

  • Dentist
  • New Lenox, IL
  • NPI 1619458148
  NPD (past)
• Niyati Bhakta, DDS

  • General Practice Dentistry
  • Homewood, IL
  • NPI 1629824214
  NPD (past)
• Steven F Biagini, D.D.S.

  • Dentist
  • Glen Ellyn, IL
  • NPI 1215965587
  NPD (past)
• Audrey Brakensiek, DMD

  • General Practice Dentistry
  • Bethalto, IL
  • NPI 1437083482
  NPD (past)
• Sarah Rose Devivo, DMD

  • General Practice Dentistry
  • La Grange, IL
  • NPI 1427743368
  NPD (past)

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

{
    "created_epoch": "1424217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632873600000",
    "number": "1154712784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 W JACKSON BLVD STE 210",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606043048",
            "telephone_number": "312-800-1270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "195 S MAIN ST",
            "city": "DUPO",
            "state": "IL",
            "postal_code": "622391347",
            "telephone_number": "312-800-1270"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "115 S Wilke Rd Ste 104",
            "address_purpose": "LOCATION",
            "city": "Arlington Heights",
            "state": "IL",
            "postal_code": "600051500",
            "country_code": "US",
            "telephone_number": "847-253-0195",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "785 S Randall Rd",
            "address_purpose": "LOCATION",
            "city": "Algonquin",
            "state": "IL",
            "postal_code": "601025914",
            "country_code": "US",
            "telephone_number": "847-854-9833",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "417 E Il Route 173 Unit 113",
            "address_purpose": "LOCATION",
            "city": "Antioch",
            "state": "IL",
            "postal_code": "600029407",
            "country_code": "US",
            "telephone_number": "847-395-5550",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "417 E Il Route 173 Unit 113",
            "address_purpose": "LOCATION",
            "city": "Antioch",
            "state": "IL",
            "postal_code": "600029407",
            "country_code": "US",
            "telephone_number": "847-395-5550",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1307 E. Rand Rd",
            "address_purpose": "LOCATION",
            "city": "Arlington Heights",
            "state": "IL",
            "postal_code": "60004",
            "country_code": "US",
            "telephone_number": "847-392-4422",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1401 S Arlington Heights Rd Ste 1",
            "address_purpose": "LOCATION",
            "city": "Arlington Heights",
            "state": "IL",
            "postal_code": "600053700",
            "country_code": "US",
            "telephone_number": "847-758-0100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "708 E Bethalto Dr",
            "address_purpose": "LOCATION",
            "city": "Bethalto",
            "state": "IL",
            "postal_code": "620101871",
            "country_code": "US",
            "telephone_number": "618-377-0044",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "142 S Gary Ave Ste 102",
            "address_purpose": "LOCATION",
            "city": "Bloomingdale",
            "state": "IL",
            "postal_code": "601082226",
            "country_code": "US",
            "telephone_number": "630-283-0652",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "183 S Bloomingdale Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Bloomingdale",
            "state": "IL",
            "postal_code": "601081400",
            "country_code": "US",
            "telephone_number": "630-529-2522",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "607 S 4th St",
            "address_purpose": "LOCATION",
            "city": "Chillicothe",
            "state": "IL",
            "postal_code": "615232277",
            "country_code": "US",
            "telephone_number": "309-274-6237",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "632 S Main St",
            "address_purpose": "LOCATION",
            "city": "Creve Coeur",
            "state": "IL",
            "postal_code": "616103974",
            "country_code": "US",
            "telephone_number": "309-698-0220",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1645 S River Rd Ste 21",
            "address_purpose": "LOCATION",
            "city": "Des Plaines",
            "state": "IL",
            "postal_code": "600182206",
            "country_code": "US",
            "telephone_number": "847-299-4811",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1441 S Randall Rd Ste C",
            "address_purpose": "LOCATION",
            "city": "Geneva",
            "state": "IL",
            "postal_code": "601344625",
            "country_code": "US",
            "telephone_number": "630-402-0359",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "658 Roosevelt Rd",
            "address_purpose": "LOCATION",
            "city": "Glen Ellyn",
            "state": "IL",
            "postal_code": "601375819",
            "country_code": "US",
            "telephone_number": "630-858-0216",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "18340 Governors Hwy",
            "address_purpose": "LOCATION",
            "city": "Homewood",
            "state": "IL",
            "postal_code": "604302910",
            "country_code": "US",
            "telephone_number": "708-799-0660",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4113 N Johnsburg Rd",
            "address_purpose": "LOCATION",
            "city": "Johnsburg",
            "state": "IL",
            "postal_code": "600516323",
            "country_code": "US",
            "telephone_number": "815-344-0028",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1704 Patton Dr Ste 1",
            "address_purpose": "LOCATION",
            "city": "Mahomet",
            "state": "IL",
            "postal_code": "618538137",
            "country_code": "US",
            "telephone_number": "217-586-7878",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "19721 Wolf Rd",
            "address_purpose": "LOCATION",
            "city": "Mokena",
            "state": "IL",
            "postal_code": "604481307",
            "country_code": "US",
            "telephone_number": "708-479-5865",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1661 Feehanville Dr Ste 420",
            "address_purpose": "LOCATION",
            "city": "Mount Prospect",
            "state": "IL",
            "postal_code": "600566045",
            "country_code": "US",
            "telephone_number": "847-635-0117",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2073 E Laraway Rd",
            "address_purpose": "LOCATION",
            "city": "New Lenox",
            "state": "IL",
            "postal_code": "604519507",
            "country_code": "US",
            "telephone_number": "815-463-5865",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7620 N University St",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "IL",
            "postal_code": "616141297",
            "country_code": "US",
            "telephone_number": "309-693-0043",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1318 W Candletree Dr",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "IL",
            "postal_code": "616148508",
            "country_code": "US",
            "telephone_number": "309-692-6206",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10904 N Main St",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "IL",
            "postal_code": "600717717",
            "country_code": "US",
            "telephone_number": "815-862-1112",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1301 N Alpine Rd",
            "address_purpose": "LOCATION",
            "city": "Rockford",
            "state": "IL",
            "postal_code": "611072262",
            "country_code": "US",
            "telephone_number": "815-397-4280",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "40W177 Campton Xing Dr Unit B",
            "address_purpose": "LOCATION",
            "city": "St Charles",
            "state": "IL",
            "postal_code": "601756594",
            "country_code": "US",
            "telephone_number": "630-443-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "28365 Davis Pkwy Ste 206",
            "address_purpose": "LOCATION",
            "city": "Warrenville",
            "state": "IL",
            "postal_code": "605553034",
            "country_code": "US",
            "telephone_number": "630-836-8995",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "57 Danada Sq E",
            "address_purpose": "LOCATION",
            "city": "Wheaton",
            "state": "IL",
            "postal_code": "601898484",
            "country_code": "US",
            "telephone_number": "630-528-0717",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "644 Sheridan Rd # 105",
            "address_purpose": "LOCATION",
            "city": "Winthrop Harbor",
            "state": "IL",
            "postal_code": "600961350",
            "country_code": "US",
            "telephone_number": "847-872-5626",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EDP OF ILLINOIS P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-18",
        "last_updated": "2021-09-29",
        "certification_date": "2021-09-14",
        "status": "A",
        "authorized_official_last_name": "GARIBAY",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "312-736-8963"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "021.001656",
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Affordable Dental of Illnois",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Community Unit School District No 196
• Michael Robert Dambacher, PTA
• Kimberly Davis, PLPC
• Nicholas Michael Dubina, DMD
• Dupo Fire Protection District
• Hannah Frances Goodson, MS, CF-SLP
• Holon Inclusive Behavioral Health
• Jessica Whelan LLC (Holon Inclusive Health System)
• John Norman Kimmich, DDS
• Ken Kloess, D.M.D.

• Dental Clinic/Center in Dupo, IL
• Providers in Dupo, IL by specialty
• Dental Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2021; 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.