Prairie Dental of Oak Park LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

PRAIRIE DENTAL OF OAK PARK LLC

Practice address

1010 Lake St
Oak Park, IL 60301-1147

Phone

(219) 465-8627

NPI assigned

Jul 19, 2019

Organization subpart

No

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

Authorized official

Name

Oscar G Gonzalez

Title

Director of Operations

Phone

(219) 465-8627

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1563494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563494400000",
    "number": "1831742733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 LAKE ST",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011147",
            "telephone_number": "219-465-8627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 LAKE ST",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011147",
            "telephone_number": "219-465-8627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE DENTAL OF OAK PARK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-19",
        "last_updated": "2019-07-19",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "OSCAR",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "219-465-8627"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Oak Park, IL
• Providers in Oak Park, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2019; 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.