Johnsburg Dental Center

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

JOHNSBURG DENTAL CENTER

Practice address

4113 Johnsburg Road
Johnsburg, IL 60050-2123

Phone

(815) 344-0028

Fax

(815) 344-2466

NPI assigned

Jul 16, 2007

Last updated

Jul 16, 2007By 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

Dr. Conrad Walter Mazeski, DDSNPI 1801079090

Title

President

Phone

(815) 344-0028

Specialties & licenses 3

Addresses

Locations

Practitioners 2

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.

• Conrad Walter Mazeski, DDS

  • General Practice Dentistry
  • Johnsburg, IL
  • NPI 1801079090
  NPD (past) Authorized official
• Dilan Shah, DMD

  • General Practice Dentistry
  • Johnsburg, IL
  • NPI 1033008362
  NPD (past)

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

{
    "created_epoch": "1184544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184544000000",
    "number": "1184823569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4113 JOHNSBURG ROAD",
            "city": "JOHNSBURG",
            "state": "IL",
            "postal_code": "600502123",
            "telephone_number": "815-344-0028",
            "fax_number": "815-344-2466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4113 JOHNSBURG ROAD",
            "city": "JOHNSBURG",
            "state": "IL",
            "postal_code": "600502123",
            "telephone_number": "815-344-0028",
            "fax_number": "815-344-2466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNSBURG DENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-16",
        "last_updated": "2007-07-16",
        "status": "A",
        "authorized_official_last_name": "MAZESKI",
        "authorized_official_first_name": "CONRAD",
        "authorized_official_middle_name": "WALTER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-344-0028",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert J Gerken, D.C.
• Traci A Gerner, O.T.R./L
• Michael Gould, PHARMD
• Heather Gunderson, MA, LMFT
• Stacy Hubley, MS LPC
• Johnsburg School District 12
• Thomas Kaczynski
• Jessica Kitto
• Juliann Evelyn Kostecki
• Thomas Little

• General Practice Dentistry in Johnsburg, IL
• Providers in Johnsburg, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2007; 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.