NPIMap

Organization Active NPI

G.R. Clemens, D.D.S., P.C.

  • General Practice Dentistry
  • Berwyn, IL
National Provider Identifier
1497015721
Registry record updated May 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
19015658 Issued in IL
Legal business name
G.R. CLEMENS, D.D.S., P.C.
Practice address
3340 Oak Park Ave.
Suite 301
Berwyn, IL 60402-3483
Phone
(708) 795-1255
Fax
(708) 795-1215
NPI assigned
May 21, 2012
Last updated
May 21, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2012

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

Authorized official

Name
G. R. Clemens, D.D.S.
Title
Dentist
Phone
(708) 795-1255

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 19015658 IL Primary

Addresses

Primary practice location

3340 Oak Park Ave.
Suite 301
Berwyn, IL 60402-3483

Mailing address

3340 Oak Park Ave.
Suite 301
Berwyn, IL 60402-3483
Phone (708) 795-1255

National Provider Directory

National Provider Directory

Locations

3340 Oak Park Ave
Ste 301
Berwyn, IL 60402
Phone (708) 795-1255

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1337558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337558400000",
    "number": "1497015721",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 OAK PARK AVE.",
            "address_2": "SUITE 301",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604023483",
            "telephone_number": "708-795-1255",
            "fax_number": "708-795-1215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3340 OAK PARK AVE.",
            "address_2": "SUITE 301",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604023483",
            "telephone_number": "708-795-1255",
            "fax_number": "708-795-1215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "G.R. CLEMENS, D.D.S., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-21",
        "last_updated": "2012-05-21",
        "status": "A",
        "authorized_official_last_name": "CLEMENS",
        "authorized_official_first_name": "G.",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "708-795-1255",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "19015658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berwyn, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 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.