Active NPI
Scott A. Soderquist, D.D.S.
- Orthodontics and Dentofacial Orthopedics Dentistry
- Joliet, IL
National Provider Identifier
1477883270
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 021002112
- Practice address
- 1118 N Larkin Ave
Joliet, IL 60435-3456 - Phone
- (815) 725-4070
- Fax
- (815) 725-4054
- NPI assigned
- Dec 30, 2009
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 021002112 | IL | Primary |
Addresses
Primary practice location
1118 N Larkin Ave
Joliet, IL 60435-3456
Mailing address
1118 N Larkin Ave
Joliet, IL 60435-3456
Phone (815) 725-4070
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Apr 19, 2016 through Apr 19, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021002112 | IL | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1262131200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1262131200000",
"number": "1477883270",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1118 N LARKIN AVE",
"city": "JOLIET",
"state": "IL",
"postal_code": "604353456",
"telephone_number": "815-725-4070",
"fax_number": "815-725-4054"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1118 N LARKIN AVE",
"city": "JOLIET",
"state": "IL",
"postal_code": "604353456",
"telephone_number": "815-725-4070",
"fax_number": "815-725-4054"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SODERQUIST",
"first_name": "SCOTT",
"middle_name": "A.",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-12-30",
"last_updated": "2009-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "IL",
"license": "021002112",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Joliet, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.