Mark J Peloquin, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Practice address

15915 S Crystal Creek Dr Ste B
Homer Glen, IL 60491-9381

Phone

(708) 301-8660

Fax

(708) 301-8661

NPI assigned

Jul 19, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dr. Edward J. Brennan, Jr. D.D.S. & Dr. Mark J. Peloquin, D.D.S. PC

  • Dentist
  • Homer Glen, IL
  • NPI 1891910303
  NPD (past) Authorized official

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1346269008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15915 S CRYSTAL CREEK DR STE B",
            "city": "HOMER GLEN",
            "state": "IL",
            "postal_code": "604919381",
            "telephone_number": "708-301-8660",
            "fax_number": "708-301-8661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15915 S CRYSTAL CREEK DR STE B",
            "city": "HOMER GLEN",
            "state": "IL",
            "postal_code": "604919381",
            "telephone_number": "708-301-8660",
            "fax_number": "708-301-8661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELOQUIN",
        "first_name": "MARK",
        "middle_name": "J",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Helen Owens, P.T.
• Genabeth M Panes, LPT
• Panozzo Therapy, Inc
• Lisa Ann Panozzo, LCSW
• Patricia Clark MD LLC
• W Michael Petty, ATC, LAT
• Phoenix Surgical Services
• Physical Therapy & Spine Institute LP
• Emily Pieper, PTA
• Judith Polkow, P.T.

• General Practice Dentistry in Homer Glen, IL
• Providers in Homer Glen, 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 Jul 8, 2007; 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.