NPIMap

Organization Active NPI

Green Bay Trail Dentistry

  • Dentist
  • Evanston, IL
National Provider Identifier
1457405987
Registry record updated May 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019021406 Issued in IL
Legal business name
GREEN BAY TRAIL DENTISTRY
Practice address
2632 Green Bay Rd
Evanston, IL 60201
Phone
(847) 869-4844
NPI assigned
Jan 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2011

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

Authorized official

Name
Eric Estes, DDSNPI 1952776809
Title
Owner Provider
Phone
(847) 869-4844

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 019021406 IL Primary

Addresses

Primary practice location

2632 Green Bay Rd
Evanston, IL 60201

Mailing address

2632 Green Bay Rd
Evanston, IL 60201
Phone (847) 869-4844

Other names 1

  • Eric Estes Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306195200000",
    "number": "1457405987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2632 GREEN BAY RD",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "60201",
            "telephone_number": "847-869-4844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2632 GREEN BAY RD",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "60201",
            "telephone_number": "847-869-4844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN BAY TRAIL DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2011-05-24",
        "status": "A",
        "authorized_official_last_name": "ESTES",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OWNER PROVIDER",
        "authorized_official_telephone_number": "847-869-4844",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019021406",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eric Estes",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Evanston, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2011; 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.