Dental Associates of South Ridge, P.C.

Primary specialty

DentistTaxonomy code 122300000X

License

019028057 Issued in IL

Legal business name

DENTAL ASSOCIATES OF SOUTH RIDGE, P.C.

Practice address

6121 Washington St
#202
Gurnee, IL 60031-5305

Phone

(847) 625-9897

NPI assigned

Sep 1, 2016

Last updated

Sep 1, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Priyadarshini Boinpally, DDS

Title

President

Phone

(847) 625-9897

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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.

• Chris P. Ullmann, D.D.S.

  • General Practice Dentistry
  • Gurnee, IL
  • NPI 1689887861
  NPD (past)

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

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472688000000",
    "number": "1396292884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "483 EVERGREEN DR",
            "city": "VERNON HILLS",
            "state": "IL",
            "postal_code": "600612907",
            "telephone_number": "847-625-9897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6121 WASHINGTON ST",
            "address_2": "#202",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600315305",
            "telephone_number": "847-625-9897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL ASSOCIATES OF SOUTH RIDGE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-01",
        "last_updated": "2016-09-01",
        "status": "A",
        "authorized_official_last_name": "BOINPALLY",
        "authorized_official_first_name": "PRIYADARSHINI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-625-9897",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019028057",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deerpath Physicians Group LTD
• Omaima Degani, M.D.
• Delany Dental Care
• Ieve Villamil Deleon, PT
• Sandra N Denman, PA-C
• Dental Professionals of Illinois, P.C. (Woodland Family Dental Care)
• Lisa Victoria Depasquale
• Narendra M Desai, MD
• Henry Deters
• Sonja M Dewey, MS, LMFT

• Dentist in Gurnee, IL
• Providers in Gurnee, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; 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.