PERIODONTAL MEDICINE AND SURGICAL SPECIALISTS, LLC (NPI# 1811036718) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1811036718 |
Entity Type | Organization |
Organization Name | PERIODONTAL MEDICINE AND SURGICAL SPECIALISTS, LLC |
Other Organization Name | PERIODONTAL MEDICINE AND SURGICAL SPECIALISTS, LTD |
Practice Address |
1s224 Summit Ave Suite 205 Oakbrook Terrace IL 60181-3983 |
Practice Telephone | 6306273930 |
Practice Fax Number | 6306272148 |
Mailing Telephone | 6306273930 |
Mailing Fax Number | 6306272148 |
Enumeration Date | 2007-02-06 |
Last Update Date | 2016-12-16 |
Authorized Official Name | GEORGE A MANDELARIS (OWNER PERIODONTIST) |
Authorized Official Telephone | 6306273930 |
Authorized Official Credential | DDS |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 1223P0300X |
Dentist Specialization: Periodontics |
019030200 | IL | Dental Providers |
N | 1223P0300X |
Dentist Specialization: Periodontics |
019024971 | IL | Dental Providers |
N | 1223P0300X |
Dentist Specialization: Periodontics |
019014972 | IL | Dental Providers |
Y | 261QD0000X |
Clinic/Center Specialization: Dental |
060-003629 | IL | Ambulatory Health Care Facilities |
Other Name | Type Code |
---|---|
Periodontal Medicine and Surgical Specialists, LTD | Former Legal Business Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1386098390 | Periodontal Medicine and Surgical Specialists, LLC | Clinic/Center | 1009 W Webster Ave, Chicago, IL 60614-3502 | 2016-04-15 |
1588703490 | Periodontal Medicine and Surgical Specialists, LLC | Dentist | 1875 Dempster St, Suite 250, Park Ridge, IL 60068-1186 | 2007-02-06 |
Street Address |
1S224 SUMMIT AVE SUITE 205 |
City | OAKBROOK TERRACE |
State | IL |
Zip Code | 60181-3983 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1174519862 | Kamal N. Ibrahim | Orthopaedic Surgery | 1s224 Summit Ave, Suite 203, Oakbrook Terrace, IL 60181-3983 | 2005-09-27 |
1194076802 | Caitlin Marie Flicek | Speech-Language Pathologist | 1s224 Summit Ave, Suite 101, Oakbrook Terrace, IL 60181-3983 | 2012-09-21 |
1215291901 | Bradley S Degroot | Dentist | 1s224 Summit Ave, #205, Oakbrook Terrace, IL 60181-3983 | 2012-06-27 |
1619237872 | Soft Landing Interventions | Community/Behavioral Health | 1s224 Summit Ave, Suite 310, Oakbrook Terrace, IL 60181-3983 | 2012-05-22 |
1275892333 | Soft Landing Interventions | Clinic/Center | 1s224 Summit Ave, Suite 310, Oakbrook Terrace, IL 60181-3983 | 2012-05-10 |
1811255813 | Rizwana Mughal | Internal Medicine | 1s224 Summit Ave, Suite 310, Oakbrook Terrace, IL 60181-3983 | 2012-04-26 |
1609149566 | Soft Landing Intervention | Community/Behavioral Health | 1s224 Summit Ave, Oakbrook Terrace, IL 60181-3983 | 2012-02-22 |
1588893929 | Lea Ann Minalga | Counselor | 1s224 Summit Ave, Suite 310, Oakbrook Terrace, IL 60181-3983 | 2009-07-07 |
1275774044 | Acmi Pain Care LLC | Anesthesiology | 1s224 Summit Ave, Ste 301, Oakbrook Terrace, IL 60181-3983 | 2009-03-09 |
1962647917 | Julie Mather Jourdan | Physician Assistant | 1s224 Summit Ave, Suite 106, Oakbrook Terrace, IL 60181-3983 | 2008-12-04 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1144820812 | Molly Ahitow | Pharmacist | 900 Il-83, Villa Park, IL 60181 | 2020-10-30 |
1881200343 | Podiatric Management Systems LLC | Podiatrist | 1 S067 Summit Ave, Oakbrook Terrace, IL 60181 | 2020-09-21 |
1093320855 | Rci (wrs), LLC. | Clinic/Center | 17 West 580 Butterfield Road, Oakbrook Terrace, IL 60181 | 2020-09-09 |
1720600992 | Mariam Ali | Pharmacist | 900 S. Rt 83, Villa Park, IL 60181 | 2020-05-11 |
1255970067 | Lifecare Pharmacy Plus LLC | Pharmacy | 1634 Ardmore Ave, Villa Park, IL 60181 | 2019-12-26 |
1497229215 | For Eyes Optical of Pa | Optometrist | 17 W 412-414 22nd St, Ste M&n, Oakbrook Terrace, IL 60181 | 2019-01-15 |
1114499928 | Next Step Physiotherapy LLC | Clinic/Center | 1 Parkview Plaza, Oakbrook Terrace, IL 60181 | 2018-12-19 |
1912482654 | Avertrail Dialysis LLC | Clinic/Center | 196 W. North Avenue, Villa Park, IL 60181 | 2018-09-28 |
1922588581 | Neeliyara Inc | Psychologist | 1s045 Spring Road, Unit 1g, Oakbrook Terrace, IL 60181 | 2018-08-14 |
1588168439 | Deborah Marie Adolfino | Pedorthist | 1s376 Summit Ave., Ct. E, Oakbrook Terrace, IL 60181 | 2018-03-23 |
Find all providers in zip 60181 |
Taxonomy Code | 261QD0000X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Dental |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1730457201 | Oakbrook Orthodontics | Clinic/Center | 17 W 727 Butterfield Road, Suite A, Oakbrook Terrace, IL 60181 | 2011-12-12 |
1518144906 | Oak Brook Smiles, P.C. | Clinic/Center | 1s132 Summit Ave, #200, Oakbrook Terrace, IL 60181-3955 | 2008-01-28 |
1649455692 | Westbrook Dental Center PC | Clinic/Center | 1 Transam Plaza Dr, Suite 160, Oakbrook Terrace, IL 60181-4822 | 2008-01-08 |
1669588778 | Phyllis A. Dixon Dds PC | Clinic/Center | 17w620 14th St, Ste. G, Oakbrook Terrace, IL 60181-3768 | 2006-08-22 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1124629514 | Chicago Pediatric Dentistry and Orthodontics | Clinic/Center | 1136 S Delano Ct W Ste B202, Chicago, IL 60605-3734 | 2020-11-03 |
1437750031 | Secure Dental Xi | Clinic/Center | 1843 W Golf Rd, Schaumburg, IL 60194-1148 | 2020-11-02 |
1780283267 | Jenna Gaw, Dds, Pllc | Clinic/Center | 1724 Locust Pl Apt 303, Schaumburg, IL 60173-4239 | 2020-10-26 |
1740889344 | Nsp Dental LLC | Clinic/Center | 1900 Hollister Dr Ste 190, Libertyville, IL 60048-5283 | 2020-10-23 |
1285232827 | Paul Doodes Dds Phd PC | Clinic/Center | 45 S Park Blvd Ste 190, Glen Ellyn, IL 60137-6282 | 2020-10-15 |
1780290676 | Great Smile Dental Pllc | Clinic/Center | 720 Osterman Ave Ste 304, Deerfield, IL 60015-4339 | 2020-09-16 |
1669087375 | Naperville Smiles Dental | Clinic/Center | 8 W Gartner Rd Ste 124, Naperville, IL 60540-7549 | 2020-09-09 |
1649883364 | Mark J Maly Estate | Clinic/Center | 103 S Main St # Po, Orangeville, IL 61060-9244 | 2020-08-24 |
1760094718 | Stoffel and Tomazin Dental Associates, Ltd | Clinic/Center | 5718 W 35th St, Cicero, IL 60804-4222 | 2020-08-20 |
1215548771 | Meda Dental II LLC | Clinic/Center | 2735 Hassert Blvd Ste 159, Naperville, IL 60564-5205 | 2020-08-10 |
Find all providers with the same taxonomy |
City | OAKBROOK TERRACE |
Zip Code | 60181 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.