Active NPI
Walter John Jagodzinski, D.D.S.
- Dentist
- Chicago, IL
National Provider Identifier
1609084482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 19A14077
- Practice address
- 6426 N Northwest Hwy
Chicago, IL 60631-1450 - Phone
- (773) 631-5200
- Fax
- (773) 631-5755
- NPI assigned
- May 18, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 19A14077 | IL | Primary |
Addresses
Primary practice location
6426 N Northwest Hwy
Chicago, IL 60631-1450
Mailing address
903 W Whitegate Dr
Mount Prospect, IL 60056-3062
Phone (773) 631-5200
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 |
|---|---|---|---|
| 19A14077 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1609084482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "903 W WHITEGATE DR",
"city": "MOUNT PROSPECT",
"state": "IL",
"postal_code": "600563062",
"telephone_number": "773-631-5200",
"fax_number": "773-631-5755"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6426 N NORTHWEST HWY",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606311450",
"telephone_number": "773-631-5200",
"fax_number": "773-631-5755"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAGODZINSKI",
"first_name": "WALTER",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "19A14077",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.