Luis Granados DDS PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

LUIS GRANADOS DDS PC

Practice address

1660 Glen Ellyn Rd
Glendale Heights, IL 60139-2504

Phone

(630) 474-0976

NPI assigned

May 15, 2023

Last updated

Apr 10, 2025By 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. Luis Granados Paucar, DDSNPI 1063948222

Title

President

Phone

(630) 474-0976

Specialties & licenses 1

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.

• Luis Gregorio Granados Paucar, DDS

  • General Practice Dentistry
  • Glendale Heights, IL
  • NPI 1063948222
  NPD Authorized official
• Amit Pithva, D.D.S.

  • General Practice Dentistry
  • Glendale Heights, IL
  • NPI 1740486265
  NPD

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

{
    "created_epoch": "1684108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744243200000",
    "number": "1205526035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1660 GLEN ELLYN RD",
            "city": "GLENDALE HEIGHTS",
            "state": "IL",
            "postal_code": "601392504",
            "telephone_number": "630-474-0976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1660 GLEN ELLYN RD",
            "city": "GLENDALE HEIGHTS",
            "state": "IL",
            "postal_code": "601392504",
            "telephone_number": "630-474-0976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUIS GRANADOS DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-15",
        "last_updated": "2025-04-10",
        "certification_date": "2025-04-10",
        "status": "A",
        "authorized_official_last_name": "GRANADOS PAUCAR",
        "authorized_official_first_name": "LUIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-474-0976",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lifesource Health and Wellness Center LLC
• Tara Marie Lindstrom, PSY.D
• Sherieka A Linzy
• Debra Locklear
• Dennis Long, DHSC, CCP
• Kaitlin Jeannette Mach, DMD
• Sumitha Mahkri
• Dennis Edward Mahoney, R.PH., MPS
• Jose Manuel Malagon Jr.
• Subbashini Marimuthu, D.M.D

• Dental Clinic/Center in Glendale Heights, IL
• Providers in Glendale Heights, 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 Apr 10, 2025; 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.