NPIMap

Organization Active NPI

Walter Tatch, D.D.S., LTD.

Doing business as Center for Oral and Facial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Gurnee, IL
National Provider Identifier
1356423891
Registry record updated Aug 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
021002076 Issued in IL
Legal business name
WALTER TATCH, D.D.S., LTD.
Doing business as
Center for Oral and Facial Surgery
Practice address
310 S Greenleaf St Ste 203
Gurnee, IL 60031-5708
Phone
(847) 623-5915
Fax
(847) 623-1174
NPI assigned
Oct 20, 2006
Last updated
Aug 14, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2013

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

Authorized official

Name
Dr. Diana Mandel-TatchNPI 1942382494
Title
Office Manager
Phone
(972) 898-5336

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 021002076 IL Primary

Addresses

Primary practice location

310 S Greenleaf St Ste 203
Gurnee, IL 60031-5708

Mailing address

310 S Greenleaf St Ste 203
Gurnee, IL 60031-5708
Phone (847) 623-5915

Other names 1

  • CENTER FOR ORAL AND FACIAL SURGERY Doing business as

National Provider Directory

National Provider Directory

Locations

310 S Greenleaf St
Ste 203
Gurnee, IL 60031
Phone (847) 623-5915

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376438400000",
    "number": "1356423891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 S GREENLEAF ST STE 203",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600315708",
            "telephone_number": "847-623-5915",
            "fax_number": "847-623-1174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 S GREENLEAF ST STE 203",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600315708",
            "telephone_number": "847-623-5915",
            "fax_number": "847-623-1174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALTER TATCH, D.D.S., LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2013-08-14",
        "status": "A",
        "authorized_official_last_name": "MANDEL-TATCH",
        "authorized_official_first_name": "DIANA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "972-898-5336",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "021002076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CENTER FOR ORAL AND FACIAL SURGERY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gurnee, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2013; 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.