DR. GLENN FREDERICK EDMISTON (NPI# 1295847036) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295847036 |
| Entity Type | Individual |
| Full Name | DR. GLENN FREDERICK EDMISTON |
| Credential | DDS MS |
| Practice Address |
302 N Hammes Ave Suite #4 Joliet IL 60435-8117 |
| Practice Telephone | 8157410301 |
| Practice Fax Number | 8057413033 |
| Mailing Telephone | 8157410301 |
| Mailing Fax Number | 8057413033 |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
IL | Dental Providers | |
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
IL | Dental Providers |
| Street Address |
302 N HAMMES AVE SUITE #4 |
| City | JOLIET |
| State | IL |
| Zip Code | 60435-8117 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922207968 | Surgical Ltd | Surgery | 302 N Hammes Ave, Joliet, IL 60435-8117 | 2007-07-11 |
| 1326144676 | Saeed Darbandi | Surgery | 302 N Hammes Ave, Joliet, IL 60435-8117 | 2006-09-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851889018 | Chime Ajiere | Nurse Practitioner | 511 Theodore St, Joliet, IL 60435 | 2018-04-24 |
| 1740791284 | Melanie Presnak | Speech-Language Pathologist | 1207 N Larkin Ave, Joliet, IL 60435 | 2017-10-23 |
| 1831618883 | Jeriel Marsena Quarles | Licensed Practical Nurse | 1617 W Jefferson Street, Joliet, IL 60435 | 2017-09-11 |
| 1053769760 | Cody Hutchinson | Physical Therapy Assistant | 2943 W Jefferson St, Joliet, IL 60435 | 2016-06-03 |
| 1659748549 | Megan Ryab | Massage Therapist | 501 Wilcox St, Joliet, IL 60435 | 2015-08-26 |
| 1922416197 | Kodo Care, Inc. | Pharmacy | 221 Springfield Avenue, Suite A, Joliet, IL 60435 | 2014-07-31 |
| 1528489739 | My Family Doc LLC | Family Medicine | 2001-03 Essington Rd, Joliet, IL 60435 | 2013-12-16 |
| 1184973869 | R A Lombardi Dds PC | Dentist | 3011 Theodore St., Joliet, IL 60435 | 2012-09-10 |
| 1245546076 | Kelly Rae Lesemann | Chiropractor | 1011 Essington Road, Joliet, IL 60435 | 2010-08-31 |
| 1932413697 | Ann E Todd | Optometrist | 1521 Essington Road, Everything In Sight, Joliet, IL 60435 | 2010-08-04 |
| Find all providers in zip 60435 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760601272 | James John Babiuk | Dentist | 3209 Fiday Rd, Joliet, IL 60431 | 2007-04-24 |
| 1639291875 | Joliet Oral Surgeons | Dentist | 1011 W Jefferson St, Joliet, IL 60435-6811 | 2007-04-06 |
| 1710462130 | The Centre for Oral Surgery In Joliet, Inc. | Dentist | 3209 Fiday Rd, Joliet, IL 60431-0644 | 2018-10-02 |
| 1891014528 | Stephen Morimoto | Dentist | 219 N Hammes Ave, Joliet, IL 60435-8114 | 2010-05-20 |
| 1437355013 | Stephen P Morimoto, Dds, Ltd | Dentist | 219 N Hammes Ave, Joliet, IL 60435-8114 | 2007-06-21 |
| 1417158320 | The Centre for Oral Surgery In Joliet, Inc. | Dentist | 3209 Fiday Rd, Joliet, IL 60431-0644 | 2007-05-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255986576 | Othman Rezki | Dentist | 1900 W Polk St # 611, Chicago, IL 60612-3723 | 2019-08-04 |
| 1215410584 | David Peterson | Dentist | 1619 Brandywine Ln, Dixon, IL 61021-8757 | 2018-09-12 |
| 1952887374 | Winnebago Braces, LLC. | Dentist | 555 N Court St Ste 110, Rockford, IL 61103-6898 | 2018-07-18 |
| 1093232951 | Robert C. Bosack, Dds & Associates, Ltd | Dentist | 16011 108th Ave Ste A, Orland Park, IL 60467-8787 | 2017-08-23 |
| 1790146132 | Family Millennium Dentistry, Inc. | Dentist | 1342 W Randolph St, Chicago, IL 60607-1522 | 2016-03-13 |
| 1770962375 | Eunsu Jung | Dentist | 1902 N Prospect Ave Ste 1, Champaign, IL 61822-1411 | 2015-05-28 |
| 1811374945 | Alexandria Hawkins | Dentist | 6050 Brynwood Dr Ste 102, Rockford, IL 61114-6579 | 2015-04-27 |
| 1043607872 | Alissa Nicole Pullos | Dentist | 105 E 1st St Ste 103, Hinsdale, IL 60521 | 2015-04-20 |
| 1538592654 | Matthew Seena Hamedani | Dentist | 3116 Oak Park Ave, Berwyn, IL 60402 | 2013-08-13 |
| 1578907689 | M Timothy Murphy | Dentist | 500 Davis St Ste 509, Evanston, IL 60201-4621 | 2013-04-18 |
| Find all providers with the same taxonomy | ||||
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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.