Active NPI
Susmitha Edukutharayil, DMD
- Dentist
- Glenview, IL
National Provider Identifier
1629850714
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019034388
- Practice address
- 9709 N Milwaukee Ave
Glenview, IL 60025-6002 - Phone
- (630) 674-6210
- NPI assigned
- Oct 16, 2023
- Sex
- Female
- 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 | 019034388 | IL | Primary |
Addresses
Primary practice location
9709 N Milwaukee Ave
Glenview, IL 60025-6002
Mailing address
9709 N Milwaukee Ave
Glenview, IL 60025
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 |
|---|---|---|---|
| 019034388 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1697414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1697414400000",
"number": "1629850714",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9709 N MILWAUKEE AVE",
"city": "GLENVIEW",
"state": "IL",
"postal_code": "60025"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9709 N MILWAUKEE AVE",
"city": "GLENVIEW",
"state": "IL",
"postal_code": "600256002",
"telephone_number": "630-674-6210"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDUKUTHARAYIL",
"first_name": "SUSMITHA",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-10-16",
"last_updated": "2023-10-16",
"certification_date": "2023-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019034388",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glenview, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.