NPIMap

Organization Active NPI

Periodontal Medicine and Surgical Specialists, LLC

  • Periodontics
  • Glenview, IL
National Provider Identifier
1790432219
Registry record updated Mar 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
Legal business name
PERIODONTAL MEDICINE AND SURGICAL SPECIALISTS, LLC
Practice address
2300 Lehigh Ave Ste 210
Glenview, IL 60026-1691
Phone
(630) 627-3930
NPI assigned
Mar 4, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2022

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

Authorized official

Name
Molly Walsh
Title
Practice Operations Director
Phone
(630) 627-3930

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0300X Primary
Dental Clinic/Center 261QD0000X

Addresses

Primary practice location

2300 Lehigh Ave Ste 210
Glenview, IL 60026-1691

Mailing address

1S224 Summit Ave Ste 205
Oakbrook Terrace, IL 60181-3943
Phone (630) 627-3930

National Provider Directory

National Provider Directory
Tax ID family
Periodontal Medicine and Surgical Specialists LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2300 Lehigh Ave
Ste 210
Glenview, IL 60026
Phone (630) 627-3930

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1646352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646352000000",
    "number": "1790432219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1S224 SUMMIT AVE STE 205",
            "city": "OAKBROOK TERRACE",
            "state": "IL",
            "postal_code": "601813943",
            "telephone_number": "630-627-3930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 LEHIGH AVE STE 210",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600261691",
            "telephone_number": "630-627-3930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERIODONTAL MEDICINE AND SURGICAL SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-04",
        "last_updated": "2022-03-04",
        "certification_date": "2022-03-04",
        "status": "A",
        "authorized_official_last_name": "WALSH",
        "authorized_official_first_name": "MOLLY",
        "authorized_official_title_or_position": "PRACTICE OPERATIONS DIRECTOR",
        "authorized_official_telephone_number": "630-627-3930"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glenview, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2022; 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.