Dental Professionals of Old Orchard LTD

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

Legal business name

DENTAL PROFESSIONALS OF OLD ORCHARD LTD

Practice address

4905 Old Orchard Ctr Ste 728
Skokie, IL 60077-4734

Phone

(847) 676-1432

NPI assigned

Aug 17, 2021

Last updated

Oct 12, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David Schwartz, DDS

Title

Owner

Phone

(847) 519-2873

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Bryan Jacobs, DMD, MS

  • Prosthodontics
  • Skokie, IL
  • NPI 1386079689
  NPD (past)
• Jennifer Moeller, DMD

  • Prosthodontics
  • Chicago, IL
  • NPI 1336672831
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633996800000",
    "number": "1710653225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4905 OLD ORCHARD CTR STE 728",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600774734",
            "telephone_number": "847-676-1432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4905 OLD ORCHARD CTR STE 728",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600774734",
            "telephone_number": "847-676-1432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PROFESSIONALS OF OLD ORCHARD LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-17",
        "last_updated": "2021-10-12",
        "certification_date": "2021-10-12",
        "status": "A",
        "authorized_official_last_name": "SCHWARTZ",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-519-2873",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dempster Medical & Chiropractic Clinic SC
• Denenberg Medical SC
• Ami Denenberg, MSED, EDS
• Jeffrey Henry Denninger, PA-C
• Dental Art of Skokie, PLLC (Dental Art of Skokie)
• Dental Sleep Center Richard a Craig DDS LTD (Midwest Dental Sleep Center)
• Dental Store North Shore, LTD (Old Orchard Smiles)
• Dependable Care Staffing, LLC
• Patricia Depoli, M.D.
• Sergey Viktorovich Dergachev

• Customized Equipment (DME) in Skokie, IL
• Providers in Skokie, IL by specialty
• Customized Equipment (DME) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.