NPIMap

Individual provider Active NPI

Michael J Gonda

  • Dentist
  • Lisle, IL
National Provider Identifier
1417124686
Registry record updated May 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019016697 Issued in IL
Practice address
4745 Main Street
Suite 201
Lisle, IL 60532
Phone
(630) 968-5078
Fax
(630) 968-3621
NPI assigned
May 15, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 019016697 IL Primary

Addresses

Primary practice location

4745 Main Street
Suite 201
Lisle, IL 60532

Mailing address

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

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
019016697ILMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Michael J Gonda DDS LTD Dentist Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1210809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210809600000",
    "number": "1417124686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4745 MAIN STREET",
            "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 STREET",
            "address_2": "SUITE 201",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "60532",
            "telephone_number": "630-968-5078",
            "fax_number": "630-968-3621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONDA",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-15",
        "last_updated": "2008-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019016697",
            "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 May 15, 2008; 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.