Individual provider Active NPI

Nathan Morris Sirota, DDS

  • Dentist
  • Palos Heights, IL
National Provider Identifier
1720153521
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Practice address
7350 West College Drive
Suite 206
Palos Heights, IL 60463
Phone
(708) 671-1050
Fax
(708) 671-1052
NPI assigned
Nov 21, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X IL Primary

Addresses

Primary practice location

7350 West College Drive
Suite 206
Palos Heights, IL 60463

Mailing address

7350 West College Drive
Suite 206
Palos Heights, IL 60463
Phone (708) 671-1050

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.
Opted out of Medicare
Yes, effective May 2, 2016 through May 2, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
019013456ILMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720153521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7350 WEST COLLEGE DRIVE",
            "address_2": "SUITE 206",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "60463",
            "telephone_number": "708-671-1050",
            "fax_number": "708-671-1052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7350 WEST COLLEGE DRIVE",
            "address_2": "SUITE 206",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "60463",
            "telephone_number": "708-671-1050",
            "fax_number": "708-671-1052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIROTA",
        "first_name": "NATHAN",
        "middle_name": "MORRIS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palos Heights, IL

Sources for this page

Verify at the official NPI Registry.