Main Street Square Dental, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

MAIN STREET SQUARE DENTAL, LLC

Practice address

2932 Finley Rd
Downers Grove, IL 60515-1042

Phone

(630) 629-6299

NPI assigned

Nov 7, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Robert Peterson, DMDNPI 1801003314

Title

Member

Phone

(847) 624-6700

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robert Kenneth Peterson, D.M.D.

  • General Practice Dentistry
  • Downers Grove, IL
  • NPI 1801003314
  NPD (past) Authorized official

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

{
    "created_epoch": "1573084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573084800000",
    "number": "1720623325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1644 BARKEI DR",
            "city": "BATAVIA",
            "state": "IL",
            "postal_code": "605108304",
            "telephone_number": "847-624-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2932 FINLEY RD",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605151042",
            "telephone_number": "630-629-6299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET SQUARE DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-07",
        "last_updated": "2019-11-07",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "847-624-6700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renuka Mahadevan
• Deborah Mahalski, BS
• Mahen Med Supply Corp
• Rizwan Mahmood, MD
• Main Street Chiropractic and Wellness Center LTD
• Marek Majewski, PA-C
• Sandra Marie Makrias, M.A.
• Molly Patricia Maletich
• Rabindra Nath Malhotra, M.D.
• Owais M Malick, MD

• General Practice Dentistry in Downers Grove, IL
• Providers in Downers Grove, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.