NPIMap

Organization Active NPI

Periodontics & Implants, LTD.

  • Periodontics
  • Evanston, IL
National Provider Identifier
1962653600
Registry record updated Sep 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
021000596 Issued in IL
Legal business name
PERIODONTICS & IMPLANTS, LTD.
Practice address
636 Church St
Suite 707
Evanston, IL 60201-4508
Phone
(847) 491-1880
NPI assigned
Sep 30, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2008

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

Authorized official

Name
Dr. Richard C Prendergast, D.D.S., M.S.
Title
President/Periodontist
Phone
(847) 491-1880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X 021000596 IL Primary

Addresses

Primary practice location

636 Church St
Suite 707
Evanston, IL 60201-4508

Mailing address

636 Church St
Suite 707
Evanston, IL 60201-4508
Phone (847) 491-1880

National Provider Directory

National Provider Directory

Locations

636 Church St
Ste 707
Evanston, IL 60201
Phone (847) 491-1880

NPI Registry JSON

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

{
    "created_epoch": "1222732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222732800000",
    "number": "1962653600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "636 CHURCH ST",
            "address_2": "SUITE 707",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014508",
            "telephone_number": "847-491-1880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "636 CHURCH ST",
            "address_2": "SUITE 707",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014508",
            "telephone_number": "847-491-1880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERIODONTICS & IMPLANTS, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-30",
        "last_updated": "2008-09-30",
        "status": "A",
        "authorized_official_last_name": "PRENDERGAST",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT/PERIODONTIST",
        "authorized_official_telephone_number": "847-491-1880",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S., M.S."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": "021000596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evanston, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2008; 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.