NPIMap

Organization Active NPI

Prairie Dental Partners LLC

  • Dentist
  • Lisle, IL
National Provider Identifier
1669935193
Registry record updated Apr 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
PRAIRIE DENTAL PARTNERS LLC
Practice address
4746 Main St
Lisle, IL 60532-1724
Phone
(630) 968-5078
NPI assigned
Apr 11, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2019

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

Authorized official

Name
Oscar G Gonzalez
Title
Director of Operations
Phone
(219) 465-8627

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

4746 Main St
Lisle, IL 60532-1724

Mailing address

4746 Main St
Lisle, IL 60532-1724
Phone (630) 968-5078

National Provider Directory

National Provider Directory

Locations

4746 Main St
Lisle, IL 60532
Phone (630) 968-5078

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": "1554940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554940800000",
    "number": "1669935193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4746 MAIN ST",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605321724",
            "telephone_number": "630-968-5078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4746 MAIN ST",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605321724",
            "telephone_number": "630-968-5078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE DENTAL PARTNERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-11",
        "last_updated": "2019-04-11",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "OSCAR",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "219-465-8627"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lisle, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2019; 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.