Gina D Gruendeman-Gordon, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

21001479 Issued in IL

Practice address

120 Oakbrook Center Mall
Suite 600
Oak Brook, IL 60523

Phone

(630) 368-0605

Fax

(630) 368-9616

NPI assigned

May 14, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Suburban Periodontal Associates Limited

  • Periodontics
  • Oak Brook, IL
  • NPI 1578680765
  NPD (past)

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

{
    "created_epoch": "1210723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210723200000",
    "number": "1730356270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 OAKBROOK CENTER MALL",
            "address_2": "SUITE 600",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "60523",
            "telephone_number": "630-368-0605",
            "fax_number": "630-368-9616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 OAKBROOK CENTER MALL",
            "address_2": "SUITE 600",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "60523",
            "telephone_number": "630-368-0605",
            "fax_number": "630-368-9616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRUENDEMAN-GORDON",
        "first_name": "GINA",
        "middle_name": "D",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-05-14",
        "last_updated": "2008-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": "21001479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Great Oaks Medical Care SC
• Matthew Ryan Greenberg, D.C.
• James William Griesbach, DDS
• Kathleen Griffin, LCPC
• Katharine M Grinnell-Noak, PSY.D.
• Gruener Consulting, LLC
• Catherine Gruener, LCPC, NCC
• Christine M. Grygiel, MA, LCPC
• Tabitha Guillaume, LCPC
• Leslie Lynn Gum, LCSW

• Periodontics in Oak Brook, IL
• Providers in Oak Brook, IL by specialty
• Periodontics in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.