Active NPI
Jerry Dvoracek, D.D.S
- General Practice Dentistry
- Chicago, IL
National Provider Identifier
1477597862
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019021625
- Practice address
- 6169 N Northwest Hwy
Chicago, IL 60631-2140 - Phone
- (773) 792-2266
- Fax
- (773) 792-2272
- NPI assigned
- Jun 15, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019021625 | IL | Primary |
Addresses
Primary practice location
6169 N Northwest Hwy
Chicago, IL 60631-2140
Mailing address
2157 Westview Dr
Des Plaines, IL 60018-2646
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
| License | State | Type | Specialty |
|---|---|---|---|
| 019021625 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1289260800000",
"number": "1477597862",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2157 WESTVIEW DR",
"city": "DES PLAINES",
"state": "IL",
"postal_code": "600182646"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6169 N NORTHWEST HWY",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606312140",
"telephone_number": "773-792-2266",
"fax_number": "773-792-2272"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DVORACEK",
"first_name": "JERRY",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-15",
"last_updated": "2010-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019021625",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.