Charles R Soderquist, DDS

Primary specialty

DentistTaxonomy code 122300000X

Practice address

8383 W Belmont Avenue
Suite 200
River Grove, IL 60171-1083

Phone

(708) 453-1110

Fax

(708) 452-0157

NPI assigned

Oct 14, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• River Grove Clinic

  • Family Medicine Physician
  • River Grove, IL
  • NPI 1568527661
  NPD (past)
• Thtacher Woods Associates LTD

  • Dental Clinic/Center
  • River Grove, IL
  • NPI 1811150410
  NPD (past)

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

{
    "created_epoch": "1160784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1942390364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8383 W BELMONT AVENUE",
            "address_2": "SUITE 200",
            "city": "RIVER GROVE",
            "state": "IL",
            "postal_code": "601711083",
            "telephone_number": "708-453-1110",
            "fax_number": "708-452-0157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8383 W BELMONT AVENUE",
            "address_2": "SUITE 200",
            "city": "RIVER GROVE",
            "state": "IL",
            "postal_code": "601711083",
            "telephone_number": "708-453-1110",
            "fax_number": "708-452-0157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SODERQUIST",
        "first_name": "CHARLES",
        "middle_name": "R",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Shifman, D.C.
• Frank Siracusa, DDS
• Jared Sivinski, DPT
• Michael Leonard Siwek, D.D.S
• Angela Maria Snyder, MSN, FNP-BC
• James J Stawowy, PHARMACIST
• Danuta B Superson, LMT
• Susan C Balberde, MD,SC
• Thtacher Woods Associates LTD
• Village of River Grove

• All providers in River Grove, IL
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.