Foster Avenue Dental Clinic P.C.

Primary specialty

DentistTaxonomy code 122300000X

License

019019206 Issued in IL

Legal business name

FOSTER AVENUE DENTAL CLINIC P.C.

Practice address

1400 E Golf Rd
Suite 125
Des Plaines, IL 60016-1236

Phone

(847) 827-7990

Fax

(847) 827-7852

NPI assigned

Feb 23, 2011

Last updated

Feb 23, 2011By 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. Gregory H Tietzer, D.D.S.NPI 1922148378

Title

Owner

Phone

(773) 463-8860

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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.

• Gregory H. Tietzer, D.D.S.

  • General Practice Dentistry
  • Chicago, IL
  • NPI 1922148378
  NPD (past) Authorized official

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

{
    "created_epoch": "1298419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298419200000",
    "number": "1205133527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3318 W FOSTER AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606254813",
            "telephone_number": "773-463-8860",
            "fax_number": "773-463-9146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 E GOLF RD",
            "address_2": "SUITE 125",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600161236",
            "telephone_number": "847-827-7990",
            "fax_number": "847-827-7852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOSTER AVENUE DENTAL CLINIC P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-23",
        "last_updated": "2011-02-23",
        "status": "A",
        "authorized_official_last_name": "TIETZER",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-463-8860",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019019206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Foot and Ankle Surgery Facility, LTD (Regenerative Surgery Center)
• Forest View Medical Center, LTD.
• Forever Care Home Visiting Physicians Inc
• Mitzi Ann Tiu Fornes
• Olivia C Forys, M.D.
• Roland Reginald Fouche Sr.
• Tara S. Fox, DPM
• Olive Mireille Foyet Pieplie Noubouss
• Lucille Francis, LMT
• Maria Evelin Frangioni

• Dentist in Des Plaines, IL
• Providers in Des Plaines, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2011; 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.