NPIMap

Organization Active NPI

Periodontal Medicine and Surgical Specialists, LLC

  • Dental Clinic/Center
  • Oakbrook Terrace, IL
National Provider Identifier
1811036718
Registry record updated Dec 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
060-003629 Issued in IL
Legal business name
PERIODONTAL MEDICINE AND SURGICAL SPECIALISTS, LLC
Practice address
1S224 Summit Ave
Suite 205
Oakbrook Terrace, IL 60181-3983
Phone
(630) 627-3930
Fax
(630) 627-2148
NPI assigned
Feb 6, 2007
Last updated
Dec 16, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2016

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

Authorized official

Name
George A Mandelaris, DDSNPI 1356568513
Title
Owner Periodontist
Phone
(630) 627-3930

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0300X 019024971 IL
PeriodonticsGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0300X 019014972 IL
PeriodonticsGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0300X 019030200 IL
Dental Clinic/Center 261QD0000X 060-003629 IL Primary

Addresses

Primary practice location

1S224 Summit Ave
Suite 205
Oakbrook Terrace, IL 60181-3983

Mailing address

1S224 Summit Ave
Suite 205
Oakbrook Terrace, IL 60181-3983
Phone (630) 627-3930

Other names 1

  • Periodontal Medicine and Surgical Specialists, LTD Former legal business name

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.

Practitioners & affiliated clinicians

Practitioners 1

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": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481846400000",
    "number": "1811036718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1S224 SUMMIT AVE",
            "address_2": "SUITE 205",
            "city": "OAKBROOK TERRACE",
            "state": "IL",
            "postal_code": "601813983",
            "telephone_number": "630-627-3930",
            "fax_number": "630-627-2148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1S224 SUMMIT AVE",
            "address_2": "SUITE 205",
            "city": "OAKBROOK TERRACE",
            "state": "IL",
            "postal_code": "601813983",
            "telephone_number": "630-627-3930",
            "fax_number": "630-627-2148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERIODONTAL MEDICINE AND SURGICAL SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2016-12-16",
        "status": "A",
        "authorized_official_last_name": "MANDELARIS",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER PERIODONTIST",
        "authorized_official_telephone_number": "630-627-3930",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": "019024971",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": "019014972",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": "019030200",
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": "060-003629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Periodontal Medicine and Surgical Specialists, LTD",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Oakbrook Terrace, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 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.