Michelle P Jennings, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

021001561 Issued in IL

Practice address

6520 Joliet Rd
Countryside, IL 60525

Phone

(708) 354-4545

Fax

(708) 354-0336

NPI assigned

Apr 23, 2007

Last updated

Aug 11, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lagrange Periodontics, LTD

  • Periodontics
  • Countryside, IL
  • NPI 1023175775
  NPD (past) Authorized official
• Lagrange Perio LLC

  dba Lagrange Periodontics

  • Periodontics
  • Countryside, IL
  • NPI 1518689546
  NPD (past)

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533945600000",
    "number": "1205054541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 ST CHARLES CT",
            "city": "LOCKPORT",
            "state": "IL",
            "postal_code": "604413676",
            "telephone_number": "815-838-5042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6520 JOLIET RD",
            "city": "COUNTRYSIDE",
            "state": "IL",
            "postal_code": "60525",
            "telephone_number": "708-354-4545",
            "fax_number": "708-354-0336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENNINGS",
        "first_name": "MICHELLE",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-23",
        "last_updated": "2018-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": "021001561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marisa Iannotta
• Jennifer James, MHS, OTR/L
• Margaret J Janes, APRN BC
• Alan M Janusek, D.D.S.
• Evyan Jawad, MB,CHB
• Giancarlo Jerry
• Edwin D Johnson
• Gina Bernice Johnson, R.N.
• Margaret Mary Johnson
• Shannon Johnson

• Periodontics in Countryside, IL
• Providers in Countryside, IL by specialty
• Periodontics in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.