Glenn Robert Groselak

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019021314 Issued in IL

Practice address

15531 E 127TH St
Lemont, IL 60439-8555

Phone

(630) 257-6350

NPI assigned

May 8, 2008

Sex

Male

Sole proprietor

Yes

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1210204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210204800000",
    "number": "1962679035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15531 E 127TH ST",
            "city": "LEMONT",
            "state": "IL",
            "postal_code": "604398555",
            "telephone_number": "630-257-6350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15531 E 127TH ST",
            "city": "LEMONT",
            "state": "IL",
            "postal_code": "604398555",
            "telephone_number": "630-257-6350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROSELAK",
        "first_name": "GLENN",
        "middle_name": "ROBERT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-05-08",
        "last_updated": "2008-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019021314",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda P Ghanayem, PHARM.D.
• Michaela Gold
• Amber Gonzalez
• Katherine O Gorski, P.T.
• Jacek Grela, M.D.
• Jacob G Groselak, DMD
• Amanda Grzeslo, CADC
• GTF Rehabilitation Services Corp
• Karen Habercoss
• Susan Hamdan, LCPC

• General Practice Dentistry in Lemont, IL
• Providers in Lemont, IL by specialty
• General Practice Dentistry in Illinois

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