Active NPI
Priya Katwala
- Pediatric Dentistry
- Long Grove, IL
National Provider Identifier
1720583545
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 021.003113
- Practice address
- 4160 Il-83
Ste 308
Long Grove, IL 60047 - Phone
- (847) 634-6166
- NPI assigned
- Mar 25, 2018
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 021.003113 | IL | Primary |
Addresses
Primary practice location
4160 Il-83
Ste 308
Long Grove, IL 60047
Mailing address
4160 Il-83
Ste 308
Long Grove, IL 60047
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 |
|---|---|---|---|
| 021.003113 | IL | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Professional Dental Alliance of Illinois Specialty, PLLC | Pediatric Dentistry | Current | 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.
-
- Pediatric Dentistry
- Long Grove, IL
- NPI 1558145227
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1521936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677196800000",
"number": "1720583545",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4160 IL-83",
"address_2": "STE 308",
"city": "LONG GROVE",
"state": "IL",
"postal_code": "60047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4160 IL-83",
"address_2": "STE 308",
"city": "LONG GROVE",
"state": "IL",
"postal_code": "60047",
"telephone_number": "847-634-6166"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KATWALA",
"first_name": "PRIYA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-03-25",
"last_updated": "2023-02-24",
"certification_date": "2023-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "IL",
"license": "021.003113",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Long Grove, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.