Niles Dental Care P.C.

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

NILES DENTAL CARE P.C.

Practice address

8031 N Milwaukee Ave
Niles, IL 60714-2827

Phone

(847) 470-0240

NPI assigned

Nov 29, 2016

Organization subpart

No

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

Authorized official

Name

Robert Arthur Sandusky, DDS

Title

President

Phone

(847) 470-0240

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Niles dental care p.c. Former legal business name

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

{
    "created_epoch": "1480377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480377600000",
    "number": "1780127480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8031 N MILWAUKEE AVE",
            "city": "NILES",
            "state": "IL",
            "postal_code": "607142827",
            "telephone_number": "847-470-0240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8031 N MILWAUKEE AVE",
            "city": "NILES",
            "state": "IL",
            "postal_code": "607142827",
            "telephone_number": "847-470-0240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NILES DENTAL CARE P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-29",
        "last_updated": "2016-11-29",
        "status": "A",
        "authorized_official_last_name": "SANDUSKY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "ARTHUR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-470-0240",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "primary": true
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dental Hygienist",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1205056413",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Niles dental care p.c.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 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.