NPIMap

Organization Active NPI

Main Square Dental

  • Dentist
  • Roscoe, IL
National Provider Identifier
1922457126
Registry record updated Jun 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
19016896 Issued in IL
Legal business name
MAIN SQUARE DENTAL
Practice address
5392 Williams Dr
Roscoe, IL 61073-7320
Phone
(815) 623-9292
NPI assigned
Jun 8, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2016

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

Authorized official

Name
Dr. Martha Muldowney
Title
Dr
Phone
(815) 623-9292

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 19016896 IL Primary

Addresses

Primary practice location

5392 Williams Dr
Roscoe, IL 61073-7320

Mailing address

5392 Williams Dr
Roscoe, IL 61073-7320
Phone (815) 623-9292

National Provider Directory

National Provider Directory

Locations

5392 Williams Dr
Roscoe, IL 61073
Phone (815) 623-9292

NPI Registry JSON

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

{
    "created_epoch": "1465344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465344000000",
    "number": "1922457126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5392 WILLIAMS DR",
            "city": "ROSCOE",
            "state": "IL",
            "postal_code": "610737320",
            "telephone_number": "815-623-9292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5392 WILLIAMS DR",
            "city": "ROSCOE",
            "state": "IL",
            "postal_code": "610737320",
            "telephone_number": "815-623-9292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN SQUARE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-08",
        "last_updated": "2016-06-08",
        "status": "A",
        "authorized_official_last_name": "MULDOWNEY",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_title_or_position": "DR",
        "authorized_official_telephone_number": "815-623-9292",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "19016896",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roscoe, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2016; 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.