Individual provider Active NPI

Donald Otto Nelson, DDS

  • General Practice Dentistry
  • Hoffman Estates, IL
National Provider Identifier
1962408401
Registry record updated Oct 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019013534 Issued in IL
Practice address
1475 Glen Lake Rd
Hoffman Estates, IL 60169
Phone
(847) 882-2620
Fax
(847) 882-0254
NPI assigned
Jun 21, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 019-013534 IL
General Practice Dentistry 1223G0001X 019013534 IL Primary

Addresses

Primary practice location

1475 Glen Lake Rd
Hoffman Estates, IL 60169

Mailing address

1475 Glen Lake Rd
Hoffman Estates, IL 60169
Phone (847) 882-2620

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150302002484 IL Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 2062738479

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019-013534ILMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Webster Dental Care of Hoffman Estates, PC General Practice Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540339200000",
    "number": "1962408401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1475 GLEN LAKE RD",
            "city": "HOFFMAN ESTATES",
            "state": "IL",
            "postal_code": "60169",
            "telephone_number": "847-882-2620",
            "fax_number": "847-882-0254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1475 GLEN LAKE RD",
            "city": "HOFFMAN ESTATES",
            "state": "IL",
            "postal_code": "60169",
            "telephone_number": "847-882-2620",
            "fax_number": "847-882-0254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "DONALD",
        "middle_name": "OTTO",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-21",
        "last_updated": "2018-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019-013534",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019013534",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hoffman Estates, IL

Sources for this page

Verify at the official NPI Registry.