Elk Grove Dental, LLC

Primary specialty

DentistTaxonomy code 122300000X

License

019.025459 Issued in IL

Legal business name

ELK GROVE DENTAL, LLC

Practice address

1121 Nerge Rd
Elk Grove Village, IL 60007-3260

Phone

(847) 895-0000

NPI assigned

Jan 9, 2016

Organization subpart

No

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

Authorized official

Name

A. Khan

Title

Staff

Phone

(847) 895-0000

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1452297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455753600000",
    "number": "1336505171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 NERGE RD",
            "city": "ELK GROVE VILLAGE",
            "state": "IL",
            "postal_code": "600073260",
            "telephone_number": "847-895-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 NERGE RD",
            "city": "ELK GROVE VILLAGE",
            "state": "IL",
            "postal_code": "600073260",
            "telephone_number": "847-895-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELK GROVE DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-09",
        "last_updated": "2016-02-18",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "A.",
        "authorized_official_title_or_position": "STAFF",
        "authorized_official_telephone_number": "847-895-0000"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.025459",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.024689",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Elk Grove Village, IL
• Providers in Elk Grove Village, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2016; 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.