NPIMap

Individual provider Active NPI

Magdalena Marianna Gryglak, D.M.D

  • General Practice Dentistry
  • Lisle, IL
National Provider Identifier
1780069740
Registry record updated Jan 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019.030257 Issued in IL
Practice address
4712 Main St
Lisle, IL 60532-1749
Phone
(630) 964-0944
NPI assigned
Jul 20, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 019.030257 IL Primary

Addresses

Primary practice location

4712 Main St
Lisle, IL 60532-1749

Mailing address

9812 Sayre Ave 3D
Chicago Ridge, IL 60415
Phone (773) 727-4356

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

LicenseStateTypeSpecialty
019.030257ILMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Lisle Dental Center P.C. General Practice Past Accepting new patients
Neeta F. Bhushan DDS PC Past Accepting new patients

Organizations & group practices 2

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": "1437350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452038400000",
    "number": "1780069740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9812 SAYRE AVE 3D",
            "city": "CHICAGO RIDGE",
            "state": "IL",
            "postal_code": "60415",
            "telephone_number": "773-727-4356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4712 MAIN ST",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605321749",
            "telephone_number": "630-964-0944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRYGLAK",
        "first_name": "MAGDALENA",
        "middle_name": "MARIANNA",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-20",
        "last_updated": "2016-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.030257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lisle, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2016; 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.