Active NPI
Paul A Homerding, DDS
- Dentist
- Mokena, IL
National Provider Identifier
1841395159
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 1915665
- Practice address
- 11244 La Porte Road
Mokena, IL 60448 - Phone
- (708) 479-2203
- Fax
- (708) 479-2412
- NPI assigned
- Sep 13, 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 | 1915665 | IL | Primary |
Addresses
Primary practice location
11244 La Porte Road
Mokena, IL 60448
Mailing address
11244 La Porte Road PO Box 283
Mokena, IL 60448
Phone (708) 479-2203
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1915665 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1841395159",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11244 LA PORTE ROAD PO BOX 283",
"city": "MOKENA",
"state": "IL",
"postal_code": "60448",
"telephone_number": "708-479-2203",
"fax_number": "708-479-2412"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11244 LA PORTE ROAD",
"city": "MOKENA",
"state": "IL",
"postal_code": "60448",
"telephone_number": "708-479-2203",
"fax_number": "708-479-2412"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOMERDING",
"first_name": "PAUL",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "1915665",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mokena, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.