NPIMap

Organization Active NPI

Old Town Dental Associates LTD

  • General Practice Dentistry
  • Crete, IL
National Provider Identifier
1801859137
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
OLD TOWN DENTAL ASSOCIATES LTD
Practice address
1397 Main St
Crete, IL 60417-2951
Phone
(708) 672-5353
NPI assigned
Apr 8, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Angela R. Bammann, DMD
Title
Pres
Phone
(708) 672-5353

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X IL Primary

Addresses

Primary practice location

1397 Main St
Crete, IL 60417-2951

Mailing address

1397 Main St
P.O.Box 37
Crete, IL 60417-2951
Phone (708) 672-5353

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1144454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801859137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1397 MAIN ST",
            "address_2": "P.O.BOX 37",
            "city": "CRETE",
            "state": "IL",
            "postal_code": "604172951",
            "telephone_number": "708-672-5353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1397 MAIN ST",
            "city": "CRETE",
            "state": "IL",
            "postal_code": "604172951",
            "telephone_number": "708-672-5353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD TOWN DENTAL ASSOCIATES LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BAMMANN",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRES",
        "authorized_official_telephone_number": "708-672-5353",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crete, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.