NPIMap

Organization Active NPI

Denemark Periodontal Specialists, LTD.

  • Periodontics
  • Burr Ridge, IL
National Provider Identifier
1902042534
Registry record updated Nov 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
0109022926 Issued in IL
Legal business name
DENEMARK PERIODONTAL SPECIALISTS, LTD.
Practice address
570 Village Center Dr
Suite 202B
Burr Ridge, IL 60527-4520
Phone
(630) 654-4141
Fax
(630) 654-4242
NPI assigned
Jan 3, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2010

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

Authorized official

Name
Dr. Paul John Denemark, DDS, MSDNPI 1114163185
Title
President/Owner
Phone
(630) 654-4141

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X 0109022926 IL Primary

Addresses

Primary practice location

570 Village Center Dr
Suite 202B
Burr Ridge, IL 60527-4520

Mailing address

570 Village Center Dr
Suite 202B
Burr Ridge, IL 60527-4520
Phone (630) 654-4141

National Provider Directory

National Provider Directory

Locations

570 Village Center Dr
Ste 202B
Burr Ridge, IL 60527
Phone (630) 654-4141

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1230940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290988800000",
    "number": "1902042534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "570 VILLAGE CENTER DR",
            "address_2": "SUITE 202B",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605274520",
            "telephone_number": "630-654-4141",
            "fax_number": "630-654-4242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "570 VILLAGE CENTER DR",
            "address_2": "SUITE 202B",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605274520",
            "telephone_number": "630-654-4141",
            "fax_number": "630-654-4242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENEMARK PERIODONTAL SPECIALISTS, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-03",
        "last_updated": "2010-11-29",
        "status": "A",
        "authorized_official_last_name": "DENEMARK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "630-654-4141",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MSD"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": "0109022926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burr Ridge, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2010; 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.