Active NPI
Isabella Renae Duarte, DDS
- General Practice Dentistry
- Berwyn, IL
National Provider Identifier
1215783295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019035411
- Practice address
- 3218 Kenilworth Ave
Berwyn, IL 60402-3003 - Phone
- (708) 797-9377
- NPI assigned
- Apr 29, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019035411 | IL | Primary |
Addresses
Primary practice location
3218 Kenilworth Ave
Berwyn, IL 60402-3003
Mailing address
6N969 Whispering Trail Road
Saint Charles, IL 60175
Phone (630) 284-9894
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019035411 | IL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jonathan Oh DDS PLLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Berwyn, IL
- NPI 1710831045
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1714348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722211200000",
"number": "1215783295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6N969 WHISPERING TRAIL ROAD",
"city": "SAINT CHARLES",
"state": "IL",
"postal_code": "60175",
"telephone_number": "630-284-9894"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3218 KENILWORTH AVE",
"city": "BERWYN",
"state": "IL",
"postal_code": "604023003",
"telephone_number": "708-797-9377"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUARTE",
"first_name": "ISABELLA",
"middle_name": "RENAE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-04-29",
"last_updated": "2024-07-29",
"certification_date": "2024-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019035411",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berwyn, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.