NPIMap

Organization Active NPI

Glen Ellyn Family Dental Care

  • Dentist
  • Glen Ellyn, IL
National Provider Identifier
1487731808
Registry record updated Feb 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019019339 Issued in IL
Legal business name
GLEN ELLYN FAMILY DENTAL CARE
Practice address
658 Roosevelt Rd
Glen Ellyn, IL 60137
Phone
(630) 858-0216
Fax
(630) 858-0022
NPI assigned
Nov 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2012

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

Authorized official

Name
Mrs. Debbie A Sansone
Title
Office Manager
Phone
(630) 858-0216

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 019019339 IL Primary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 019023247 IL
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 019021405 IL

Addresses

Primary practice location

658 Roosevelt Rd
Glen Ellyn, IL 60137

Mailing address

658 Roosevelt Rd
Glen Ellyn, IL 60137
Phone (630) 858-0216

Other names 1

  • Dr Theresa M Jansky DDS Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329264000000",
    "number": "1487731808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "658 ROOSEVELT RD",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "60137",
            "telephone_number": "630-858-0216",
            "fax_number": "630-858-0022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "658 ROOSEVELT RD",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "60137",
            "telephone_number": "630-858-0216",
            "fax_number": "630-858-0022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLEN ELLYN FAMILY DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2012-02-15",
        "status": "A",
        "authorized_official_last_name": "SANSONE",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "630-858-0216",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019019339",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019023247",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019021405",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr Theresa M Jansky DDS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Glen Ellyn, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2012; 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.