Roger Edward Hanks, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3591-015 Issued in WI

Practice address

3001 6TH St Ste a
Naval Health Clinic -BLDG 1017
Great Lakes, IL 60088-2833

Phone

(847) 688-2100

NPI assigned

Feb 2, 2006

Sex

Male

Sole proprietor

No

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": "1138838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1225756800000",
    "number": "1659343978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 TEN PIN LN",
            "city": "BEACH PARK",
            "state": "IL",
            "postal_code": "600994511",
            "telephone_number": "847-975-3383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 6TH ST STE A",
            "address_2": "NAVAL HEALTH CLINIC -BLDG 1017",
            "city": "GREAT LAKES",
            "state": "IL",
            "postal_code": "600882833",
            "telephone_number": "847-688-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANKS",
        "first_name": "ROGER",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-02",
        "last_updated": "2008-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "3591-015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Martin Louis Gottstine, DDS
• David Lawrence Green, D.D.S.
• Sang Soo John Grzesik, DDS
• Kelsie Lynn Hammac
• Peter Jerome Hammes, DDS
• Jennifer Harte, DDS, MS
• John Paul Haxton, D.D.S
• Marla Crill Heller, R.D.
• Michael Joseph Herriges, D.D.S.
• Jennifer Morgan Hirsh, PHARMD

• General Practice Dentistry in Great Lakes, IL
• Providers in Great Lakes, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2008; 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.