Illinois Dental Providers (Glen Ellyn), LTD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

ILLINOIS DENTAL PROVIDERS (GLEN ELLYN), LTD

Practice address

701 Roosevelt Rd
Glen Ellyn, IL 60137-5805

Phone

(630) 790-8430

Fax

(216) 584-1056

NPI assigned

Oct 16, 2015

Last updated

Mar 20, 2018By the provider in NPPES

Organization subpart

Yes

Parent organization

DENTALONE PARTNERS, INC.As reported in NPPES

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

Authorized official

Name

Rachel Nittinger

Title

Manager Credentialing

Phone

(972) 755-0816

Specialties & licenses 1

Addresses

Part of

Dental One Inc

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.

• Eva Teresa Fortsas, DDS

  • General Practice Dentistry
  • Arlington Heights, IL
  • NPI 1467488742
  NPD (past)

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

{
    "created_epoch": "1444953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521504000000",
    "number": "1306217252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7160 DALLAS PKWY STE 400",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750247111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 ROOSEVELT RD",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601375805",
            "telephone_number": "630-790-8430",
            "fax_number": "216-584-1056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS DENTAL PROVIDERS (GLEN ELLYN), LTD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTALONE PARTNERS, INC.",
        "enumeration_date": "2015-10-16",
        "last_updated": "2018-03-20",
        "status": "A",
        "authorized_official_last_name": "NITTINGER",
        "authorized_official_first_name": "RACHEL",
        "authorized_official_title_or_position": "MANAGER CREDENTIALING",
        "authorized_official_telephone_number": "972-755-0816"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracy Humphrey, LCPC
• Maria F Hussain, PA-C
• Christina Tram Huynh, M.D.
• Matthew William Hyder, LCPC, CADC
• Dawnell Ibsen, PT
• Inner Hues Therapy LLC
• Innovative Imaging Solutions
• Insight Therapy Services PLLC
• Charles R Ireland, DO
• Irish Eyes LLC (DuPage Family Eyecare)

• General Practice Dentistry in Glen Ellyn, IL
• Providers in Glen Ellyn, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2018; 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.