NPIMap

Organization Active NPI

West Suburban Endodontics LLC

  • Endodontics
  • Wheaton, IL
National Provider Identifier
1821491937
Registry record updated Oct 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
021002266 Issued in IL
Legal business name
WEST SUBURBAN ENDODONTICS LLC
Practice address
1749 S Naperville Road
Suite 100
Wheaton, IL 60189
Phone
(630) 653-3636
Fax
(630) 653-3663
NPI assigned
Oct 2, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2020

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

Authorized official

Name
Dr. Brian Wardell, DMD
Title
Manager
Phone
(630) 655-3636

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
EndodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223E0200X 021002266 IL Primary

Addresses

Primary practice location

1749 S Naperville Road
Suite 100
Wheaton, IL 60189

Mailing address

1749 S Naperville Road
Suite 100
Wheaton, IL 60189
Phone (630) 653-3636

Other names 1

  • DBA Premier Endodontic Associates Other name

National Provider Directory

National Provider Directory

Locations

1749 S Naperville Rd
Ste 100
Wheaton, IL 60189
Phone (630) 653-3636

NPI Registry JSON

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

{
    "created_epoch": "1412208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604016000000",
    "number": "1821491937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1749 S NAPERVILLE ROAD",
            "address_2": "SUITE 100",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "60189",
            "telephone_number": "630-653-3636",
            "fax_number": "630-653-3663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1749 S NAPERVILLE ROAD",
            "address_2": "SUITE 100",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "60189",
            "telephone_number": "630-653-3636",
            "fax_number": "630-653-3663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST SUBURBAN ENDODONTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-02",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-30",
        "status": "A",
        "authorized_official_last_name": "WARDELL",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "630-655-3636",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": "IL",
            "license": "021002266",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DBA Premier Endodontic Associates",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Oct 30, 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.