NPIMap

Organization Active NPI

Michael J Gonda DDS LTD

  • Dentist
  • Lisle, IL
National Provider Identifier
1376658674
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
MICHAEL J GONDA DDS LTD
Practice address
4745 Main St
Suite 201
Lisle, IL 60532
Phone
(630) 968-5078
Fax
(630) 968-3621
NPI assigned
Aug 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Michael J Gonda, DDSNPI 1417124686
Title
Dr Owner
Phone
(630) 968-5078

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
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X IL Primary

Addresses

Primary practice location

4745 Main St
Suite 201
Lisle, IL 60532

Mailing address

4745 Main St
Suite 201
Lisle, IL 60532
Phone (630) 968-5078

National Provider Directory

National Provider Directory

Locations

4745 Main St
Ste 201
Lisle, IL 60532
Phone (630) 968-5078

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": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376658674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4745 MAIN ST",
            "address_2": "SUITE 201",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "60532",
            "telephone_number": "630-968-5078",
            "fax_number": "630-968-3621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4745 MAIN ST",
            "address_2": "SUITE 201",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "60532",
            "telephone_number": "630-968-5078",
            "fax_number": "630-968-3621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL J GONDA DDS LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GONDA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DR OWNER",
        "authorized_official_telephone_number": "630-968-5078",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lisle, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.