Palos Pediatric Dentistry, PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

019028264 Issued in IL

Legal business name

PALOS PEDIATRIC DENTISTRY, PC

Practice address

12800 S Ridgeland Ave
Suite H
Palos Heights, IL 60463-2390

Phone

(708) 280-9234

NPI assigned

Aug 12, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Richard Norman Facko, DDS, MS

Title

President

Phone

(708) 280-9234

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1376265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376265600000",
    "number": "1851724975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12800 S RIDGELAND AVE",
            "address_2": "SUITE H",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604632390",
            "telephone_number": "708-280-9234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12800 S RIDGELAND AVE",
            "address_2": "SUITE H",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604632390",
            "telephone_number": "708-280-9234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALOS PEDIATRIC DENTISTRY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-12",
        "last_updated": "2013-08-12",
        "status": "A",
        "authorized_official_last_name": "FACKO",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "NORMAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-280-9234",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": "019028264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Palos Heights School District 128
• Palos Heights Sleep Center LTD
• Palos Hills Pharmacy, Inc.
• Palos Medical Care SC
• Palos Pain Center
• Palos Psychiatric & Recovery Inst LTD
• Palos Psychotherapy Associates, LLC
• Palos Sleep Center LTD
• Palos Surgicenter, LLC
• Palos Vision Care, Inc

• Dental Clinic/Center in Palos Heights, IL
• Providers in Palos Heights, IL by specialty
• Dental Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2013; 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.