NPIMap

Organization Active NPI

Kids Dentist, PC

  • Pediatric Dentistry
  • Grayslake, IL
National Provider Identifier
1417916834
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
KIDS DENTIST, PC
Practice address
160 Commerce Dr
Suite 100
Grayslake, IL 60030-1601
Phone
(847) 223-1400
Fax
(847) 223-1478
NPI assigned
Mar 23, 2006
Last updated
Aug 22, 2020By the provider in NPPES
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
Mr. Don Friske
Title
Manager
Phone
(847) 223-1400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X IL Primary

Addresses

Primary practice location

160 Commerce Dr
Suite 100
Grayslake, IL 60030-1601

Mailing address

160 Commerce Dr
Suite 100
Grayslake, IL 60030-1601
Phone (847) 223-1400

National Provider Directory

National Provider Directory

Locations

160 Commerce Dr
Ste 100
Grayslake, IL 60030
Phone (847) 223-1400

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417916834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 COMMERCE DR",
            "address_2": "SUITE 100",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600301601",
            "telephone_number": "847-223-1400",
            "fax_number": "847-223-1478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 COMMERCE DR",
            "address_2": "SUITE 100",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600301601",
            "telephone_number": "847-223-1400",
            "fax_number": "847-223-1478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS DENTIST, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FRISKE",
        "authorized_official_first_name": "DON",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "847-223-1400",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grayslake, 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.