Active NPI
Jonathan Kenneth Rakstang, DDS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Burbank, IL
National Provider Identifier
1366772287
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 019.032870
- Practice address
- 7820 S Cicero Ave
Burbank, IL 60459-1584 - Phone
- (708) 391-5220
- NPI assigned
- Dec 29, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 8923 | CO | |
| Dentist | 122300000X | 3740 | AR | |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 019.032870 | IL | Primary |
Addresses
Primary practice location
7820 S Cicero Ave
Burbank, IL 60459-1584
Mailing address
547 S Clark St Apt 1004
Chicago, IL 60605-1548
Phone (303) 669-8175
Other practice location 1
4400 Rogers Ave
Suite C
Fort Smith, AR 72903-3145
Phone (303) 669-8175
Other practice location 2
7820 S Cicero Ave
Burbank, IL 60459-1584
Phone (708) 391-5220
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3740 | AR | MD | Dentist |
| 8923 | CO | MD | Dentist |
| 019.032870 | IL | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1262044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631059200000",
"number": "1366772287",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "547 S CLARK ST APT 1004",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606051548",
"telephone_number": "303-669-8175"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7820 S CICERO AVE",
"city": "BURBANK",
"state": "IL",
"postal_code": "604591584",
"telephone_number": "708-391-5220"
}
],
"practiceLocations": [
{
"address_1": "4400 Rogers Ave",
"address_2": "Suite C",
"address_purpose": "LOCATION",
"city": "Fort Smith",
"state": "AR",
"postal_code": "729033145",
"country_code": "US",
"telephone_number": "303-669-8175",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "7820 S Cicero Ave",
"address_purpose": "LOCATION",
"city": "Burbank",
"state": "IL",
"postal_code": "604591584",
"country_code": "US",
"telephone_number": "708-391-5220",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "RAKSTANG",
"first_name": "JONATHAN",
"middle_name": "KENNETH",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-12-29",
"last_updated": "2021-09-08",
"certification_date": "2021-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CO",
"license": "8923",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AR",
"license": "3740",
"primary": false
},
{
"code": "1223X0400X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "IL",
"license": "019.032870",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burbank, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.