Ellen E. Tkach, DDS, P.C.

Primary specialty

DentistTaxonomy code 122300000X

License

019-021157 Issued in IL

Legal business name

ELLEN E. TKACH, DDS, P.C.

Practice address

1464 Townline Rd
Mundelein, IL 60060-4433

Phone

(847) 566-7850

Fax

(847) 566-7851

NPI assigned

Sep 16, 2014

Last updated

Sep 16, 2014By 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. Ellen E Tkach, DDS

Title

Dentist

Phone

(847) 431-4416

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Ellen E Tkach DDS PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Ellen E Tkach, D.D.S., P.C.

  • Dentist
  • Evanston, IL
  • NPI 1700212040
  NPD tax ID

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

{
    "created_epoch": "1410825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410825600000",
    "number": "1336540863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1464 TOWNLINE RD",
            "city": "MUNDELEIN",
            "state": "IL",
            "postal_code": "600604433",
            "telephone_number": "847-566-7850",
            "fax_number": "847-566-7851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1464 TOWNLINE RD",
            "city": "MUNDELEIN",
            "state": "IL",
            "postal_code": "600604433",
            "telephone_number": "847-566-7850",
            "fax_number": "847-566-7851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLEN E. TKACH, DDS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-16",
        "last_updated": "2014-09-16",
        "status": "A",
        "authorized_official_last_name": "TKACH",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "847-431-4416",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019-021157",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1194998252",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Mundelein, IL
• Providers in Mundelein, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2014; 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.