Madison Street Dental LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

019015666 Issued in IL

Legal business name

MADISON STREET DENTAL LLC

Practice address

210 N Madison St
Woodstock, IL 60098-3450

Phone

(815) 338-7569

NPI assigned

Dec 4, 2017

Last updated

Dec 4, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kristy Wolter

Title

Insurance Manager

Phone

(630) 339-3172

Specialties & licenses 2

Addresses

Locations

Practitioners 2

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.

• David D Janes, D.D.S.

  • General Practice Dentistry
  • Woodstock, IL
  • NPI 1144526948
  NPD (past)
• Isha Parikh

  • Dentist
  • Woodstock, IL
  • NPI 1902383706
  NPD (past)

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

{
    "created_epoch": "1512345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512345600000",
    "number": "1497260152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1699 E WOODFIELD RD STE 102",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601734955",
            "telephone_number": "630-339-3172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 N MADISON ST",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "600983450",
            "telephone_number": "815-338-7569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON STREET DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-04",
        "last_updated": "2017-12-04",
        "status": "A",
        "authorized_official_last_name": "WOLTER",
        "authorized_official_first_name": "KRISTY",
        "authorized_official_title_or_position": "INSURANCE MANAGER",
        "authorized_official_telephone_number": "630-339-3172"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": "019015666",
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": "019018403",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trevor Luckey, PT
• Amy Luebke, DEM, OM,CNP,HHP
• Lumaea Wellness LLC
• Regina Leeann Lumpkins, L.C.S.W.
• Angela E Mack, RD
• Elisha Mairet, LCSW
• Maitri Therapy Services, PLLC
• Majercik Physical Therapy
• Joseph Majercik Jr., PT
• Joanna Makowski, PMHNP

• Dental Clinic/Center in Woodstock, IL
• Providers in Woodstock, IL by specialty
• Dental Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2017; 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.