NPIMap

Organization Active NPI

Nelson Ridge Family Dental

  • Dental Clinic/Center
  • New Lenox, IL
National Provider Identifier
1306111349
Registry record updated Mar 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
019.027903 Issued in IL
Legal business name
NELSON RIDGE FAMILY DENTAL
Practice address
820 Laraway Rd
New Lenox, IL 60451-2694
Phone
(815) 524-6000
NPI assigned
Mar 8, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2012

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

Authorized official

Name
Dr. Paul E Etchison, DDSNPI 1932334695
Title
Owner
Phone
(815) 524-6000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 019.027903 IL Primary

Addresses

Primary practice location

820 Laraway Rd
New Lenox, IL 60451-2694

Mailing address

820 Laraway Rd
New Lenox, IL 60451-2694

National Provider Directory

National Provider Directory

Locations

820 Laraway Rd
New Lenox, IL 60451
Phone (815) 242-9594

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1331164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331164800000",
    "number": "1306111349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 LARAWAY RD",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604512694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 LARAWAY RD",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604512694",
            "telephone_number": "815-524-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NELSON RIDGE FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-08",
        "last_updated": "2012-03-08",
        "status": "A",
        "authorized_official_last_name": "ETCHISON",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-524-6000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": "019.027903",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Lenox, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2012; 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.