NPIMap

Organization Active NPI

Professional Dental Alliance of Illinois Ortho PLLC

Doing business as Grove Dental

  • Dental Clinic/Center
  • Bolingbrook, IL
National Provider Identifier
1457987901
Registry record updated Mar 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
PROFESSIONAL DENTAL ALLIANCE OF ILLINOIS ORTHO PLLC
Doing business as
Grove Dental
Practice address
160 E Boughton Rd
Bolingbrook, IL 60440-2014
Phone
(630) 410-1766
NPI assigned
Mar 17, 2020
Last updated
Mar 17, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2020

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

Authorized official

Name
Amanda Kurtz
Title
Credentialing Specialist
Phone
(724) 698-2058

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

160 E Boughton Rd
Bolingbrook, IL 60440-2014

Mailing address

11 S Mill St Ste 200
New Castle, PA 16101-3680

Other practice location 1

6800 Main St
Downers Grove, IL 60516-3493
Phone (630) 969-5350

Other practice location 2

55 E Loop Rd Ste 201
Wheaton, IL 60189-1938
Phone (630) 653-8899

Other practice location 3

2 E 22nd St Ste 201
Lombard, IL 60148-6105
Phone (630) 627-4680

Other names 1

  • Grove Dental Doing business as

National Provider Directory

National Provider Directory

Locations

2 E 22nd St
Ste 201
Lombard, IL 60148
Phone (630) 627-4680

55 E Loop Rd
Ste 201
Wheaton, IL 60189
Phone (630) 653-8899

Practitioners & affiliated clinicians

Practitioners 29

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.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1584403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584403200000",
    "number": "1457987901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 S MILL ST STE 200",
            "city": "NEW CASTLE",
            "state": "PA",
            "postal_code": "161013680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 E BOUGHTON RD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604402014",
            "telephone_number": "630-410-1766"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6800 Main St",
            "address_purpose": "LOCATION",
            "city": "Downers Grove",
            "state": "IL",
            "postal_code": "605163493",
            "country_code": "US",
            "telephone_number": "630-969-5350",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "55 E Loop Rd Ste 201",
            "address_purpose": "LOCATION",
            "city": "Wheaton",
            "state": "IL",
            "postal_code": "601891938",
            "country_code": "US",
            "telephone_number": "630-653-8899",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2 E 22nd St Ste 201",
            "address_purpose": "LOCATION",
            "city": "Lombard",
            "state": "IL",
            "postal_code": "601486105",
            "country_code": "US",
            "telephone_number": "630-627-4680",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLIANCE OF ILLINOIS ORTHO PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-17",
        "last_updated": "2020-03-17",
        "certification_date": "2020-03-17",
        "status": "A",
        "authorized_official_last_name": "KURTZ",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "724-698-2058"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grove Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bolingbrook, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.