NPIMap

Organization Active NPI

Mark R Commean DMD LTD

  • Dentist
  • Montgomery, IL
National Provider Identifier
1417046905
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
MARK R COMMEAN DMD LTD
Practice address
20 Boulder Hill Pass
Montgomery, IL 60538-1951
Phone
(630) 896-5013
Fax
(630) 896-5108
NPI assigned
Oct 12, 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
Dr. Mark R Commean, DMDNPI 1891872958
Title
Dentist Owner
Phone
(630) 896-5013

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 01914998 IL
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X IL Primary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X IL

Addresses

Primary practice location

20 Boulder Hill Pass
Montgomery, IL 60538-1951

Mailing address

20 Boulder Hill Pass
Montgomery, IL 60538-1951
Phone (630) 896-5013

Other names 1

  • Boulder Hill Dental Associates Doing business as

National Provider Directory

National Provider Directory

Locations

20 Boulder Hill Pass
Montgomery, IL 60538
Phone (630) 896-5013

Practitioners & affiliated clinicians

Practitioners 6

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": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417046905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 BOULDER HILL PASS",
            "city": "MONTGOMERY",
            "state": "IL",
            "postal_code": "605381951",
            "telephone_number": "630-896-5013",
            "fax_number": "630-896-5108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 BOULDER HILL PASS",
            "city": "MONTGOMERY",
            "state": "IL",
            "postal_code": "605381951",
            "telephone_number": "630-896-5013",
            "fax_number": "630-896-5108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK R COMMEAN DMD LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "COMMEAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DENTIST OWNER",
        "authorized_official_telephone_number": "630-896-5013",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "01914998",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boulder Hill Dental Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Montgomery, 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.