NPIMap

Organization Active NPI

Northwestern Dental Group LTD

  • General Practice Dentistry
  • Niles, IL
National Provider Identifier
1508080110
Registry record updated Apr 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
NORTHWESTERN DENTAL GROUP LTD
Practice address
7745 N Milwaukee Ave
Niles, IL 60714-4735
Phone
(847) 967-6744
Fax
(847) 967-1460
NPI assigned
Apr 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2020

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

Authorized official

Name
Lawrence MulvaneyNPI 1992874044
Title
Owner
Phone
(847) 945-3515

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

7745 N Milwaukee Ave
Niles, IL 60714-4735

Mailing address

400 Lake Cook Rd Ste 114
Deerfield, IL 60015-4929
Phone (847) 945-3515

National Provider Directory

National Provider Directory

Locations

400 Lake Cook Rd
Ste 114
Deerfield, IL 60015

7745 N Milwaukee Ave
Niles, IL 60714
Phone (847) 967-6744

Practitioners & affiliated clinicians

Practitioners 1

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": "1176422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587600000000",
    "number": "1508080110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 LAKE COOK RD STE 114",
            "city": "DEERFIELD",
            "state": "IL",
            "postal_code": "600154929",
            "telephone_number": "847-945-3515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7745 N MILWAUKEE AVE",
            "city": "NILES",
            "state": "IL",
            "postal_code": "607144735",
            "telephone_number": "847-967-6744",
            "fax_number": "847-967-1460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWESTERN DENTAL GROUP LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-13",
        "last_updated": "2020-04-23",
        "certification_date": "2020-04-23",
        "status": "A",
        "authorized_official_last_name": "MULVANEY",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-945-3515"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Niles, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2020; 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.