Peter Joseph Waidzunas, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

19015982 Issued in IL

Practice address

501 N. Milwaukee Avenue
#119
Gurnee, IL 60031-2767

Phone

(847) 336-7300

Fax

(847) 336-1347

NPI assigned

Nov 16, 2006

Last updated

May 9, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368057600000",
    "number": "1871666917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 N. MILWAUKEE AVENUE",
            "address_2": "#119",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600312767",
            "telephone_number": "847-336-7300",
            "fax_number": "847-336-1347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 N. MILWAUKEE AVENUE",
            "address_2": "#119",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600312767",
            "telephone_number": "847-336-7300",
            "fax_number": "847-336-1347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAIDZUNAS",
        "first_name": "PETER",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-16",
        "last_updated": "2013-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "19015982",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Christine Vook, PA-C
• Danny Khai Vu, M.D.
• Waggoner Behavioral Health LLC
• Kelsey Waggoner
• Rockelle Waggoner
• Cynthia A Wait, M.D.
• Walgreen Co (Walgreens #04097)
• Walgreen Co (Walgreens #5056)
• Walid N. Ghantous MD LTD
• Walk & Play Therapy, Inc.

• General Practice Dentistry in Gurnee, IL
• Providers in Gurnee, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 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.