NPIMap

Organization Active NPI

Suburban Periodontal Associates Limited

  • Periodontics
  • Oak Brook, IL
National Provider Identifier
1578680765
Registry record updated Nov 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
021601479 Issued in IL
Legal business name
SUBURBAN PERIODONTAL ASSOCIATES LIMITED
Practice address
120 Oakbrook Center
Suite 600
Oak Brook, IL 60523
Phone
(630) 368-0605
Fax
(630) 368-9616
NPI assigned
Mar 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2015

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

Authorized official

Name
Mrs. Gina D Gruendeman, DDS
Title
President
Phone
(630) 368-0605

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0300X 021601479 IL Primary

Addresses

Primary practice location

120 Oakbrook Center
Suite 600
Oak Brook, IL 60523

Mailing address

120 Oakbrook Center
Suite 600
Oak Brook, IL 60523
Phone (630) 368-0605

National Provider Directory

National Provider Directory

Locations

120 Oakbrook Ctr
Ste 600
Oak Brook, IL 60523
Phone (630) 368-0605

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": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447113600000",
    "number": "1578680765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 OAKBROOK CENTER",
            "address_2": "SUITE 600",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "60523",
            "telephone_number": "630-368-0605",
            "fax_number": "630-368-9616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 OAKBROOK CENTER",
            "address_2": "SUITE 600",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "60523",
            "telephone_number": "630-368-0605",
            "fax_number": "630-368-9616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUBURBAN PERIODONTAL ASSOCIATES LIMITED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2015-11-10",
        "status": "A",
        "authorized_official_last_name": "GRUENDEMAN",
        "authorized_official_first_name": "GINA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-368-0605",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": "021601479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Brook, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2015; 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.