PERIODONTAL MEDICINE AND SURGICAL SPECIALISTS, LLC (NPI# 1588703490) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588703490 |
| Entity Type | Organization |
| Organization Name | PERIODONTAL MEDICINE AND SURGICAL SPECIALISTS, LLC |
| Other Organization Name | PERIODONTAL MEDICINE AND SURGICAL SPECIALISTS, LTD |
| Practice Address |
1875 Dempster St Suite 250 Park Ridge IL 60068-1186 |
| Mailing Address |
1s224 Summit Ave Suite 205 Oakbrook Terrace IL 60181-3983 |
| Practice Telephone | 8476981180 |
| Practice Fax Number | 8476981185 |
| Mailing Telephone | 6306273930 |
| Mailing Fax Number | 6306272148 |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2016-12-29 |
| Authorized Official Name | DR. 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 |
019014972 | IL | Dental Providers |
| N | 124Q00000X | Dental Hygienist | 020005282 | IL | Dental Providers |
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
019024971 | IL | Dental Providers |
| 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 |
| 1811036718 | Periodontal Medicine and Surgical Specialists, LLC | Dentist | 1s224 Summit Ave, Suite 205, Oakbrook Terrace, IL 60181-3983 | 2007-02-06 |
| Street Address |
1875 DEMPSTER ST SUITE 250 |
| City | PARK RIDGE |
| State | IL |
| Zip Code | 60068-1186 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952307092 | The Spine Center, S.c | Orthopaedic Surgery | 1875 Dempster St, Ste 425, Park Ridge, IL 60068-1129 | 2005-06-23 |
| 1124680640 | Heather Ann-marie Owens | Physical Therapist | 1875 Dempster St, Park Ridge, IL 60068-1186 | 2019-07-04 |
| 1467012187 | Eric Joseph Leadley | Nurse Practitioner | 1875 Dempster St, Park Ridge, IL 60068-1186 | 2019-06-14 |
| 1619495868 | Kelly Ryan Warf | Audiologist | 1875 Dempster St, Park Ridge, IL 60068-1186 | 2017-09-07 |
| 1164946919 | Olga Gilman | Nurse Practitioner | 1875 Dempster St, Park Ridge, IL 60068-1186 | 2017-08-02 |
| 1275060972 | Anne Frances Wright | Nurse Practitioner | 1875 Dempster St, Park Ridge, IL 60068-1186 | 2017-05-12 |
| 1558892166 | Maricar A Virina | Obstetrics & Gynecology | 1875 Dempster St, Ste. 330, Park Ridge, IL 60068 | 2017-03-24 |
| 1649711995 | Brian Saliba | Obstetrics & Gynecology | 1875 Dempster St, Suite 330, Park Ridge, IL 60068-1186 | 2017-03-19 |
| 1174069363 | Laura Hunnell | Physician Assistant | 1875 Dempster St, Suite 410, Park Ridge, IL 60068-1186 | 2017-01-11 |
| 1871035121 | Rosina Hannilora Victor | Nurse Practitioner | 1875 Dempster St, #465, Park Ridge, IL 60068-1186 | 2016-11-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861010720 | Caitlin Marie Kompanowski | Dentist | 412 W. Talcott, Park Ridge, IL 60068 | 2020-07-08 |
| 1972142198 | Center for Authentic Living, Inc. | Counselor | 120 Main Street Suite 200, Park Ridge, IL 60068 | 2020-01-06 |
| 1306312152 | Maryann Almores Devilla | Physical Medicine & Rehabilitation | Sunrise Assisted Living, 1725 Ballard Road, Park Ridge, IL 60068 | 2018-10-19 |
| 1053808857 | Landon Ginsberg | Student in an Organized Health Care Education/Training Program | 1775 Ballard, Park Ridge, IL 60068 | 2018-04-17 |
| 1255828448 | Vera W Brink | Obstetrics & Gynecology | Parkside Professional Center, 1875 Dempster St., Ste. 330, Park Ridge, IL 60068 | 2018-04-13 |
| 1205367448 | Courtney Heim | Psychiatry & Neurology | 1875 W.dempster Street - Park Side Professional Center, Ste 470, Park Ridge, IL 60068 | 2017-03-21 |
| 1720521362 | Alexander Mylonas | Psychologist | 1400 Renaissance Dr Ste 401, Park Ridge, IL 60068 | 2016-11-30 |
| 1376090878 | Rebecca Rajasekhar | Audiologist | 1030 W. Higgins Rd., Audiology Room 6, Park Ridge, IL 60068 | 2016-09-01 |
| 1164818449 | Mohammad Taha Mustaf Taha Mustafa Sheikh | Student in an Organized Health Care Education/Training Program | 1550 North Northwest Highway Suite 107, L.m. Prasad, Md, Sc, Park Ridge, IL 60068 | 2015-04-13 |
| 1518397918 | Megan Roberts | Speech-Language Pathologist | 2240 Campus Dr., Evanston, IL 60068 | 2013-11-21 |
| Find all providers in zip 60068 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275855306 | Robert C. Poulsom, D.d.s., M.s. Ltd | Dentist | 350 South Nw Highway, Ste 120, Park Ridge, IL 60068 | 2010-02-16 |
| 1164657698 | Josephine Difranco Bordignon | Dentist | 511 W. Talcoh, Park Ridge, IL 60068 | 2009-05-28 |
| 1144567595 | Park Ridge Periodontics, Inc. | Dentist | 511 W Talcott Rd, Park Ridge, IL 60068-5338 | 2013-01-04 |
| 1609955814 | Charles F Difranco | Dentist | 511 W Talcott Rd, Park Ridge, IL 60068 | 2006-11-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891309399 | Dominik Dubravec Dds Mmsc PC | Dentist | 555 W Court St Ste 202, Kankakee, IL 60901-3674 | 2020-09-02 |
| 1598374167 | Dubravec Periodontal Specialists PC | Dentist | 20635 Abbey Woods Ct N Ste 203, Frankfort, IL 60423-3186 | 2020-07-29 |
| 1972145183 | Dental Dream Team Associates LLC Yetta Mccullom Sole Mbr | Dentist | 820 E 87th St Ste 201, Chicago, IL 60619-6256 | 2019-10-09 |
| 1083192389 | Amirreza Ghassemi | Dentist | 2800 College Ave Bldg 285, Alton, IL 62002-4742 | 2018-07-30 |
| 1508355678 | Periodontal Associates, LLP | Dentist | 845 N Michigan Ave Ste 940w, Chicago, IL 60611-2216 | 2018-05-04 |
| 1043750714 | Bloomingdale Dental Rez, PC | Dentist | 1 Tiffany Pt Ste 209, Bloomingdale, IL 60108-2916 | 2017-03-01 |
| 1114398831 | Dubravec Periodontal Associates, PC | Dentist | 1900 Spring Rd, Suite 205, Oak Brook, IL 60523-1447 | 2015-10-08 |
| 1689059297 | Amer Atassi | Dentist | 6224 S Elm St, Burr Ridge, IL 60527-5228 | 2015-07-24 |
| 1013304724 | Elliott T. Deweese | Dentist | 7447 W Talcott Ave., Suite 227, Chicago, IL 60631 | 2015-04-20 |
| 1215345939 | Mark Kolozenski, Dds, Ms, PC | Dentist | 10083 W Lincoln Hwy, Frankfort, IL 60423-1272 | 2014-07-25 |
| Find all providers with the same taxonomy | ||||
| City | PARK RIDGE |
| Zip Code | 60068 |
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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.