Active NPI
Tyson L Frenzel, DDS
- Dentist
- Bolingbrook, IL
National Provider Identifier
1811065428
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019023931
- Practice address
- 160 E Boughton Rd
Bolingbrook, IL 60440-2014 - Phone
- (630) 759-8940
- NPI assigned
- Dec 1, 2006
- Sex
- Male
- 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 | 019023931 | IL | Primary |
Addresses
Primary practice location
160 E Boughton Rd
Bolingbrook, IL 60440-2014
Mailing address
14533 Colonial Pkwy
Plainfield, IL 60544
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 15921 | Other | IL | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 13, 2015 through Jul 13, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019023931 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1437955200000",
"number": "1811065428",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14533 COLONIAL PKWY",
"city": "PLAINFIELD",
"state": "IL",
"postal_code": "60544"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "160 E BOUGHTON RD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604402014",
"telephone_number": "630-759-8940"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FRENZEL",
"first_name": "TYSON",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-01",
"last_updated": "2015-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019023931",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "15921",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bolingbrook, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.