NPIMap

Organization Active NPI

Glenn J Evans DDS PC

  • Dentist
  • Wheaton, IL
National Provider Identifier
1831453307
Registry record updated Jun 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019026423 Issued in IL
Legal business name
GLENN J EVANS DDS PC
Practice address
703 Parkway Dr
Wheaton, IL 60187-3646
Phone
(630) 362-8674
NPI assigned
Jun 29, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2012

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

Authorized official

Name
Dr. Glenn Evans, DDSNPI 1538142492
Title
Dentist
Phone
(630) 362-8674

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 019026423 IL Primary

Addresses

Primary practice location

703 Parkway Dr
Wheaton, IL 60187-3646

Mailing address

703 Parkway Dr
Wheaton, IL 60187-3646

Other identifiers 1

IdentifierTypeStateIssuer
9177499MedicaidIL

National Provider Directory

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.

NPI Registry JSON

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

{
    "created_epoch": "1340928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340928000000",
    "number": "1831453307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "703 PARKWAY DR",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601873646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 PARKWAY DR",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601873646",
            "telephone_number": "630-362-8674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENN J EVANS DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-29",
        "last_updated": "2012-06-29",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "GLENN",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "630-362-8674",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019026423",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9177499",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Jun 29, 2012; 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.