Jerry E Udelson, DDS, PC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

021001495 Issued in IL

Legal business name

JERRY E UDELSON, DDS, PC

Doing business as

Little Teeth Big Smiles & Children's Dentistry

Practice address

1125 Harlem Ave
Forest Park, IL 60130-2337

Phone

(708) 386-5437

Fax

(708) 771-5439

NPI assigned

Aug 1, 2007

Last updated

Jul 17, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jerry E Udelson, DDSNPI 1013134154

Title

President

Phone

(708) 386-5437

Specialties & licenses 1

Addresses

Other names 1

• Little Teeth Big Smiles & Children's Dentistry Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Feb 4, 2016 through Feb 4, 2028

Medicare enrollment (NPD)

Not enrolled

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jerry Udelson, DDS

  • Pediatric Dentistry
  • Forest Park, IL
  • NPI 1013134154
  NPD Authorized official
• Priyal P Mangrola, DMD

  • Pediatric Dentistry
  • Lake Forest, IL
  • NPI 1023539947
  NPD
• Joshua Woodruff, DMD

  • Pediatric Dentistry
  • Forest Park, IL
  • NPI 1013331644
  NPD
• Ara Cho, D.M.D.

  • Pediatric Dentistry
  • Forest Park, IL
  • NPI 1215296942
  NPD (past)

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

{
    "created_epoch": "1185926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721174400000",
    "number": "1881885127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 HARLEM AVE",
            "city": "FOREST PARK",
            "state": "IL",
            "postal_code": "601302337",
            "telephone_number": "708-386-5437",
            "fax_number": "708-771-5439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 HARLEM AVE",
            "city": "FOREST PARK",
            "state": "IL",
            "postal_code": "601302337",
            "telephone_number": "708-386-5437",
            "fax_number": "708-771-5439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY E UDELSON, DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-01",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A",
        "authorized_official_last_name": "UDELSON",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-386-5437",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IL",
            "license": "021001495",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Little Teeth Big Smiles & Children's Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica Jacknow
• Marvin Zebedee Jackson Jr., B.S.,D.C.
• Karen Janiec, NP
• Jayreese Transportation Service
• Debra L Jensen, L. AC.
• Jin Wu PSYD LLC
• Christine Johnson, APN
• Laneta Chanelle Johnson, DT
• Julia Jordan-Lake
• Joseph & Brooks Family Therapy LLC

• Pediatric Dentistry in Forest Park, IL
• Providers in Forest Park, IL by specialty
• Pediatric Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.