NPIMap

Organization Active NPI

Premier Dental Group Personal Corporation

Doing business as West Willow Family Dental

  • Dental Clinic/Center
  • Wheaton, IL
National Provider Identifier
1801583570
Registry record updated Apr 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
PREMIER DENTAL GROUP PERSONAL CORPORATION
Doing business as
West Willow Family Dental
Practice address
300 S West St
Wheaton, IL 60187-5021
Phone
(630) 665-0650
Fax
(708) 484-0843
NPI assigned
Apr 21, 2023
Last updated
Apr 25, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2023

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

Authorized official

Name
Anthony Amodio Brucci, DMD
Title
Dentist/Owner
Phone
(708) 308-9929

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

300 S West St
Wheaton, IL 60187-5021

Mailing address

183 N Addison Ave Apt 216
Elmhurst, IL 60126-3195

Other names 1

  • West Willow Family Dental Doing business as

National Provider Directory

National Provider Directory

Locations

300 S West St
Wheaton, IL 60187
Phone (630) 665-0650

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1682035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682380800000",
    "number": "1801583570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "183 N ADDISON AVE APT 216",
            "city": "ELMHURST",
            "state": "IL",
            "postal_code": "601263195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S WEST ST",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601875021",
            "telephone_number": "630-665-0650",
            "fax_number": "708-484-0843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER DENTAL GROUP PERSONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-21",
        "last_updated": "2023-04-25",
        "certification_date": "2023-04-25",
        "status": "A",
        "authorized_official_last_name": "BRUCCI",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "AMODIO",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "708-308-9929",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Willow Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wheaton, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2023; 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.