Timothy V Erdle, D.M.D.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

019030597 Issued in IL

Practice address

310 Tri State Pkwy Ste 100
Gurnee, IL 60031-5282

Phone

(847) 662-3414

NPI assigned

Jun 19, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Timothy V Erdle DMD PLLC

  dba Institute of Dental Implants and Periodontics

  • Multi-Specialty Clinic/Center
  • Gurnee, IL
  • NPI 1700587342
  NPD Authorized official

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

{
    "created_epoch": "1403136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678406400000",
    "number": "1962816603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2424 OAK TREE LN",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681522",
            "telephone_number": "408-482-7023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 TRI STATE PKWY STE 100",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600315282",
            "telephone_number": "847-662-3414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERDLE",
        "first_name": "TIMOTHY",
        "middle_name": "V",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-19",
        "last_updated": "2023-03-10",
        "certification_date": "2023-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "PA",
            "license": "DS039810",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": "019030597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Gurnee, IL
• Providers in Gurnee, IL by specialty
• Periodontics in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2023; 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.