Active NPI
Stanley Caradine
- Dentist
- Sheridan, IL
National Provider Identifier
1922632694
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019021871
- Practice address
- 4017 E 2603Rd Rd
Sheridan, IL 60551-9502 - Phone
- (815) 496-2181
- NPI assigned
- Mar 2, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 019021871 | IL | Primary |
Addresses
Primary practice location
4017 E 2603Rd Rd
Sheridan, IL 60551-9502
Mailing address
PO Box 277849
Riverdale, IL 60827-7849
Phone (708) 986-4234
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 |
|---|---|---|---|
| 019021871 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1583107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583107200000",
"number": "1922632694",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 277849",
"city": "RIVERDALE",
"state": "IL",
"postal_code": "608277849",
"telephone_number": "708-986-4234"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4017 E 2603RD RD",
"city": "SHERIDAN",
"state": "IL",
"postal_code": "605519502",
"telephone_number": "815-496-2181"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARADINE",
"first_name": "STANLEY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-03-02",
"last_updated": "2020-03-02",
"certification_date": "2020-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019021871",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sheridan, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.