Chicagoland Implant Specialist LTD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

021001401 Issued in IL

Legal business name

CHICAGOLAND IMPLANT SPECIALIST LTD

Practice address

237 S Main St
Lombard, IL 60148-2647

Phone

(312) 533-8489

NPI assigned

Jun 13, 2016

Last updated

Jan 24, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Paul S Petrungaro, DDS

Title

Owner

Phone

(312) 415-7481

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1465776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485216000000",
    "number": "1326498130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6420 N LEHIGH AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606462704",
            "telephone_number": "312-624-9300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "237 S MAIN ST",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601482647",
            "telephone_number": "312-533-8489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICAGOLAND IMPLANT SPECIALIST LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-13",
        "last_updated": "2017-01-24",
        "status": "A",
        "authorized_official_last_name": "PETRUNGARO",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-415-7481",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": "021001401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Lombard, IL
• Providers in Lombard, IL by specialty
• Periodontics in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2017; 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.