Active NPI
Constanza E Fernandez Gonzalez, DDS, PHD
- Dentist
- Downers Grove, IL
National Provider Identifier
1801314505
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 136.000221
- Practice address
- 3450 Lacey Rd
Dental Institute
Downers Grove, IL 60515 - Phone
- (630) 515-7350
- Fax
- (630) 515-7290
- NPI assigned
- Sep 1, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 136.000221 | IL | Primary |
Addresses
Primary practice location
3450 Lacey Rd
Dental Institute
Downers Grove, IL 60515
Mailing address
555 31St Street
Science Hall, Suite 211 P
Downers Grove, IL 60515
Phone (630) 515-7350
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 23, 2018 through Jan 23, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 136.000221 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1504224000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1504224000000",
"number": "1801314505",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "555 31ST STREET",
"address_2": "SCIENCE HALL, SUITE 211 P",
"city": "DOWNERS GROVE",
"state": "IL",
"postal_code": "60515",
"telephone_number": "630-515-7350",
"fax_number": "630-515-7290"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3450 LACEY RD",
"address_2": "DENTAL INSTITUTE",
"city": "DOWNERS GROVE",
"state": "IL",
"postal_code": "60515",
"telephone_number": "630-515-7350",
"fax_number": "630-515-7290"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FERNANDEZ GONZALEZ",
"first_name": "CONSTANZA",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "DDS, PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-09-01",
"last_updated": "2017-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "136.000221",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Downers Grove, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2017; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.