Individual provider Active NPI

Michaelangelo D Aust, DDS

  • Dentist
  • Burr Ridge, IL
National Provider Identifier
1467551887
Registry record updated Dec 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
6002-15 Issued in WI
Practice address
410 Village Center Dr
Burr Ridge, IL 60527-4513
Phone
(630) 323-9550
Fax
(262) 484-4367
NPI assigned
Sep 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 6002-15 WI Primary

Addresses

Primary practice location

410 Village Center Dr
Burr Ridge, IL 60527-4513

Mailing address

410 Village Center Dr
Burr Ridge, IL 60527-4513
Phone (630) 323-9550

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120719000289 WI Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 4688830615

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6002-15WIMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
1St Family Dental of Burr Ridge, PC Dentist PastSince Dec 17, 2023 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": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702425600000",
    "number": "1467551887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 VILLAGE CENTER DR",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605274513",
            "telephone_number": "630-323-9550",
            "fax_number": "262-484-4367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 VILLAGE CENTER DR",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605274513",
            "telephone_number": "630-323-9550",
            "fax_number": "262-484-4367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AUST",
        "first_name": "MICHAELANGELO",
        "middle_name": "D",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-22",
        "last_updated": "2023-12-13",
        "certification_date": "2023-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "6002-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burr Ridge, IL

Sources for this page

Verify at the official NPI Registry.