Winthrop Harbor Dental Center

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019015026 Issued in IL

Legal business name

WINTHROP HARBOR DENTAL CENTER

Practice address

644 Sheridan Rd
Suite 105
Winthrop Harbor, IL 60096-1350

Phone

(847) 872-5626

Fax

(847) 746-2900

NPI assigned

Aug 2, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Michelle L Opelt

Title

Business Manager

Phone

(847) 872-5626

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322438400000",
    "number": "1306853429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "644 SHERIDAN RD",
            "address_2": "SUITE 105",
            "city": "WINTHROP HARBOR",
            "state": "IL",
            "postal_code": "600961350",
            "telephone_number": "847-872-5626",
            "fax_number": "847-746-2900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "644 SHERIDAN RD",
            "address_2": "SUITE 105",
            "city": "WINTHROP HARBOR",
            "state": "IL",
            "postal_code": "600961350",
            "telephone_number": "847-872-5626",
            "fax_number": "847-746-2900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WINTHROP HARBOR DENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-02",
        "last_updated": "2011-11-28",
        "status": "A",
        "authorized_official_last_name": "OPELT",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "847-872-5626",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019015026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "603323",
            "identifier": "TRI-CARE",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "80006341",
            "identifier": "BCBS OF IL",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "603323",
            "identifier": "UNITED CONCORDIA",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jackie Lynne Schilling, RPH
• Emma Slack, MSW,LSW
• Renee Teresa Stickelman, RN
• Joan Thornton, LPN
• Village of Winthrop HBR
• Winthrop Harbor School District #1

• General Practice Dentistry in Winthrop Harbor, IL
• Providers in Winthrop Harbor, 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 Nov 28, 2011; 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.