Individual provider Active NPI

Ralph Edwin Woerheide, D.D.S.

  • General Practice Dentistry
  • Olympia Fields, IL
National Provider Identifier
1407066160
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019018086 Issued in IL
Practice address
2601 Lincoln Hwy
Olympia Fields, IL 60461-1862
Phone
(708) 748-6179
Fax
(708) 748-1441
NPI assigned
May 23, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 019018086 IL Primary

Addresses

Primary practice location

2601 Lincoln Hwy
Olympia Fields, IL 60461-1862

Mailing address

2601 Lincoln Hwy
Olympia Fields, IL 60461-1862
Phone (708) 748-6179

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

LicenseStateTypeSpecialty
019018086ILMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407066160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 LINCOLN HWY",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611862",
            "telephone_number": "708-748-6179",
            "fax_number": "708-748-1441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 LINCOLN HWY",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611862",
            "telephone_number": "708-748-6179",
            "fax_number": "708-748-1441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOERHEIDE",
        "first_name": "RALPH",
        "middle_name": "EDWIN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019018086",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia Fields, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.