NPIMap

Organization Active NPI

My Geriatric Dentist

  • General Practice Dentistry
  • Des Plaines, IL
National Provider Identifier
1366064594
Registry record updated May 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MY GERIATRIC DENTIST
Practice address
2093 Rand Rd
Des Plaines, IL 60016-4727
Phone
(847) 590-1880
Fax
(708) 590-0868
NPI assigned
May 11, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2020

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

Authorized official

Name
Mrs. Lisa Blumofe, DDSNPI 1316063811
Title
Dentist
Phone
(847) 590-1880

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

2093 Rand Rd
Des Plaines, IL 60016-4727

Mailing address

2093 Rand Rd
Des Plaines, IL 60016-4727
Phone (847) 590-1880

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1589155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589155200000",
    "number": "1366064594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2093 RAND RD",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600164727",
            "telephone_number": "847-590-1880",
            "fax_number": "708-590-0868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2093 RAND RD",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600164727",
            "telephone_number": "847-590-1880",
            "fax_number": "708-590-0868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY GERIATRIC DENTIST",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-11",
        "last_updated": "2020-05-11",
        "certification_date": "2020-05-11",
        "status": "A",
        "authorized_official_last_name": "BLUMOFE",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "847-590-1880",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Plaines, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2020; 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.