Kenneth Howard Peskin, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Practice address

4711 Golf Rd
Suite 408
Skokie, IL 60076-1224

Phone

(847) 676-4590

Fax

(847) 676-4695

NPI assigned

Aug 1, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619983244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4711 GOLF RD",
            "address_2": "SUITE 408",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600761224",
            "telephone_number": "847-676-4590",
            "fax_number": "847-676-4695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4711 GOLF RD",
            "address_2": "SUITE 408",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600761224",
            "telephone_number": "847-676-4590",
            "fax_number": "847-676-4695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PESKIN",
        "first_name": "KENNETH",
        "middle_name": "HOWARD",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Periodontics LTD.
• Jeannette Rebecca Perkal, MAAT, LPC
• Judith Lea Perlman, M.S.W.
• Blair Valentine Person, M.S., CCC-SLP
• Peskin Oral Surgery, LTD.
• Peter Rooney LTD
• Christina M Peters, PHD
• Dora Navarro Peters, MS OTRL
• Katherine Elisabeth Peters, PA-C
• Abigail Peterson

• Oral and Maxillofacial Surgery (Dentist) in Skokie, IL
• Providers in Skokie, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.