NPIMap

Organization Active NPI

Thomas L. Prendergast, DDS, PC

  • General Practice Dentistry
  • Fox Lake, IL
National Provider Identifier
1639438765
Registry record updated May 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019-022387 Issued in IL
Legal business name
THOMAS L. PRENDERGAST, DDS, PC
Practice address
1394 S Route 12
Fox Lake, IL 60020-1949
Phone
(847) 587-5053
NPI assigned
May 9, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2012

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

Authorized official

Name
Dr. Thomas L. Prendergast, DDSNPI 1124124821
Title
President
Phone
(847) 587-5053

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 019-022387 IL Primary

Addresses

Primary practice location

1394 S Route 12
Fox Lake, IL 60020-1949

Mailing address

1394 S Route 12
Fox Lake, IL 60020-1949

National Provider Directory

National Provider Directory

Locations

1394 S US Highway 12
Fox Lake, IL 60020
Phone (847) 587-5053

Practitioners & affiliated clinicians

Practitioners 2

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": "1336521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336521600000",
    "number": "1639438765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1394 S ROUTE 12",
            "city": "FOX LAKE",
            "state": "IL",
            "postal_code": "600201949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1394 S ROUTE 12",
            "city": "FOX LAKE",
            "state": "IL",
            "postal_code": "600201949",
            "telephone_number": "847-587-5053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOMAS L. PRENDERGAST, DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-09",
        "last_updated": "2012-05-09",
        "status": "A",
        "authorized_official_last_name": "PRENDERGAST",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-587-5053",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019-022387",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fox Lake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2012; 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.