Active NPI
Ronald Louis Eldridge, D.D.S.
- General Practice Dentistry
- Homewood, IL
National Provider Identifier
1902060163
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019018962
- Practice address
- 2640 183Rd St
Homewood, IL 60430-2914 - Phone
- (708) 206-1277
- Fax
- (708) 206-1351
- NPI assigned
- Jul 16, 2008
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019018962 | IL | Primary |
Addresses
Primary practice location
2640 183Rd St
Homewood, IL 60430-2914
Mailing address
2640 183Rd St
Homewood, IL 60430-2914
Phone (708) 206-1277
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 |
|---|---|---|---|
| 019018962 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216166400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1216166400000",
"number": "1902060163",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2640 183RD ST",
"city": "HOMEWOOD",
"state": "IL",
"postal_code": "604302914",
"telephone_number": "708-206-1277",
"fax_number": "708-206-1351"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2640 183RD ST",
"city": "HOMEWOOD",
"state": "IL",
"postal_code": "604302914",
"telephone_number": "708-206-1277",
"fax_number": "708-206-1351"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELDRIDGE",
"first_name": "RONALD",
"middle_name": "LOUIS",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-07-16",
"last_updated": "2008-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019018962",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Homewood, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.