Active NPI
Edward Steven Golom, DDS
- Dentist
- Willow Springs, IL
National Provider Identifier
1700025210
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019.015546
- Practice address
- 8336 Archer Ave
Willow Springs, IL 60480-1468 - Phone
- (708) 839-9636
- NPI assigned
- Feb 8, 2009
- Sex
- Male
- 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 | 019.015546 | IL | Primary |
Addresses
Primary practice location
8336 Archer Ave
Willow Springs, IL 60480-1468
Mailing address
8336 Archer Ave
Willow Springs, IL 60480-1468
Phone (708) 839-9636
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 |
|---|---|---|---|
| 019.015546 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1234051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1234051200000",
"number": "1700025210",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8336 ARCHER AVE",
"city": "WILLOW SPRINGS",
"state": "IL",
"postal_code": "604801468",
"telephone_number": "708-839-9636"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8336 ARCHER AVE",
"city": "WILLOW SPRINGS",
"state": "IL",
"postal_code": "604801468",
"telephone_number": "708-839-9636"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLOM",
"first_name": "EDWARD",
"middle_name": "STEVEN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-02-08",
"last_updated": "2009-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019.015546",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Willow Springs, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.