Dubravec Periodontal Specialists PC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

Legal business name

DUBRAVEC PERIODONTAL SPECIALISTS PC

Practice address

20635 Abbey Woods CT N Ste 203
Frankfort, IL 60423-3186

Phone

(815) 464-3001

Fax

(815) 464-3010

NPI assigned

Jul 29, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Dominik Dubravec, DDS, MMSC

Title

Owner

Phone

(815) 464-3001

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1595980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608076800000",
    "number": "1598374167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20635 ABBEY WOODS CT N STE 203",
            "city": "FRANKFORT",
            "state": "IL",
            "postal_code": "604233186",
            "telephone_number": "815-464-3001",
            "fax_number": "815-464-3010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20635 ABBEY WOODS CT N STE 203",
            "city": "FRANKFORT",
            "state": "IL",
            "postal_code": "604233186",
            "telephone_number": "815-464-3001",
            "fax_number": "815-464-3010"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1900 Spring Rd Ste 205",
            "address_purpose": "LOCATION",
            "city": "Oak Brook",
            "state": "IL",
            "postal_code": "605231479",
            "country_code": "US",
            "telephone_number": "630-573-0369",
            "fax_number": "630-573-0234",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DUBRAVEC PERIODONTAL SPECIALISTS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-29",
        "last_updated": "2020-12-16",
        "certification_date": "2020-12-16",
        "status": "A",
        "authorized_official_last_name": "DUBRAVEC",
        "authorized_official_first_name": "DOMINIK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-464-3001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MMSC"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 1 NPI",
            "identifier": "1427122381",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Frankfort, IL
• Providers in Frankfort, IL by specialty
• Periodontics in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 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.