Individual provider Active NPI

Devang Tulsidas Thakkar, DDS, MS

  • Periodontics
  • Homewood, IL
National Provider Identifier
1710922752
Registry record updated Feb 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
21002097 Issued in IL
Practice address
18130 Halsted St
Homewood, IL 60430-2507
Phone
(708) 799-2550
NPI assigned
Jun 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Periodontics 1223P0300X 21002097 IL Primary

Addresses

Primary practice location

18130 Halsted St
Homewood, IL 60430-2507

Mailing address

4271 Linden Tree LN
Glenview, IL 60026-1224
Phone (847) 998-0207

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20130625000620 IL Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 8527207471

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
21002097ILMDPeriodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Endodontic & Periodontic Associates, LTD Periodontics Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202083200000",
    "number": "1710922752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4271 LINDEN TREE LN",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600261224",
            "telephone_number": "847-998-0207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18130 HALSTED ST",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "604302507",
            "telephone_number": "708-799-2550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THAKKAR",
        "first_name": "DEVANG",
        "middle_name": "TULSIDAS",
        "name_prefix": "Dr.",
        "credential": "DDS, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2008-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": "21002097",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Homewood, IL

Sources for this page

Verify at the official NPI Registry.