Active NPI
Kortney Spectre
- Dental Hygienist
- Great Lakes, IL
National Provider Identifier
1578333266
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 020011128
- Practice address
- 2410 Sampson St
Great Lakes, IL 60088-2942 - Phone
- (847) 688-3331
- NPI assigned
- Jan 4, 2024
- Last updated
- Jan 4, 2024
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 020011128 | IL | Primary |
Addresses
Primary practice location
2410 Sampson St
Great Lakes, IL 60088-2942
Mailing address
35915 N Watson Ave
Ingleside, IL 60041-9172
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 020011128 | IL | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1704326400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704326400000",
"number": "1578333266",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "35915 N WATSON AVE",
"city": "INGLESIDE",
"state": "IL",
"postal_code": "600419172"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2410 SAMPSON ST",
"city": "GREAT LAKES",
"state": "IL",
"postal_code": "600882942",
"telephone_number": "847-688-3331"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPECTRE",
"first_name": "KORTNEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-01-04",
"last_updated": "2024-01-04",
"certification_date": "2024-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "IL",
"license": "020011128",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Great Lakes, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.