Active NPI
Emilio Carrillo, D.D.S.
- General Practice Dentistry
- Gurnee, IL
National Provider Identifier
1396146775
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 100097715
- Practice address
- 4343 Old Grand Ave
Ste-112
Gurnee, IL 60031 - Phone
- (312) 719-2582
- NPI assigned
- Sep 4, 2014
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 100097715 | WI | Primary |
Addresses
Primary practice location
4343 Old Grand Ave
Ste-112
Gurnee, IL 60031
Mailing address
4343 Old Grand Ave
Ste-112
Gurnee, IL 60031
Phone (312) 719-2582
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 |
|---|---|---|---|
| 100097715 | WI | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1409788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1527033600000",
"number": "1396146775",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4343 OLD GRAND AVE",
"address_2": "STE-112",
"city": "GURNEE",
"state": "IL",
"postal_code": "60031",
"telephone_number": "312-719-2582"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4343 OLD GRAND AVE",
"address_2": "STE-112",
"city": "GURNEE",
"state": "IL",
"postal_code": "60031",
"telephone_number": "312-719-2582"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARRILLO",
"first_name": "EMILIO",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-09-04",
"last_updated": "2018-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WI",
"license": "100097715",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 May 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.