Glenn Frederick Edmiston, DDS MS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Practice address

302 N Hammes Ave
Suite #4
Joliet, IL 60435-8117

Phone

(815) 741-0301

Fax

(805) 741-3033

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1295847036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 N HAMMES AVE",
            "address_2": "SUITE #4",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604358117",
            "telephone_number": "815-741-0301",
            "fax_number": "805-741-3033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 N HAMMES AVE",
            "address_2": "SUITE #4",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604358117",
            "telephone_number": "815-741-0301",
            "fax_number": "805-741-3033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDMISTON",
        "first_name": "GLENN",
        "middle_name": "FREDERICK",
        "name_prefix": "Dr.",
        "credential": "DDS MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ngozi Sheila Eboru
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• Samantha Eddy, FNP-BC
• Eden Vista Joliet LLC
• Tricia Kathleen Edgerley, MA, CCC-SLP
• Brian Edwards, PHARMD
• Brian J Egan, DO
• Lori Lynn Egizio, MSW, LCSW
• John Michael Egner, RPH
• Julie Ebohon Ehizemwogie, LEVEL 2 BEHAVIOR THE

• Oral and Maxillofacial Surgery (Dentist) in Joliet, IL
• Providers in Joliet, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.