Active NPI
George Kalluvaraparampil Mathew, DDS
- Dentist
- Aurora, IL
National Provider Identifier
1942491147
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019027466
- Practice address
- 1264 B North Lake Street
Premier Dental Clinic
Aurora, IL 60506 - Phone
- (630) 801-9028
- NPI assigned
- Aug 5, 2007
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 019027466 | IL | Primary |
Addresses
Primary practice location
1264 B North Lake Street
Premier Dental Clinic
Aurora, IL 60506
Mailing address
350 N Clark Street, Suite 600
C/O Kos Services
Chicago, IL 60654
Phone (312) 274-4526
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 |
|---|---|---|---|
| 019027466 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380240000000",
"number": "1942491147",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "350 N CLARK STREET, SUITE 600",
"address_2": "C/O KOS SERVICES",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60654",
"telephone_number": "312-274-4526"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1264 B NORTH LAKE STREET",
"address_2": "PREMIER DENTAL CLINIC",
"city": "AURORA",
"state": "IL",
"postal_code": "60506",
"telephone_number": "630-801-9028"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHEW",
"first_name": "GEORGE",
"middle_name": "KALLUVARAPARAMPIL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-08-05",
"last_updated": "2013-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019027466",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Aurora, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.