JERRY E UDELSON, DDS, PC (NPI# 1881885127) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881885127 |
| Entity Type | Organization |
| Organization Name | JERRY E UDELSON, DDS, PC |
| Other Organization Name | LITTLE TEETH BIG SMILES & CHILDREN'S DENTISTRY |
| Practice Address |
1129 Harlem Ave Forest Park IL 60130-2381 |
| Practice Telephone | 7083865437 |
| Practice Fax Number | 7087715439 |
| Mailing Telephone | 7083865437 |
| Mailing Fax Number | 7087715439 |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2007-08-01 |
| Authorized Official Name | DR. JERRY E UDELSON (PRESIDENT) |
| Authorized Official Telephone | 7083865437 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
IL | Dental Providers |
| Other Name | Type Code |
|---|---|
| Little Teeth Big Smiles & Children's Dentistry | Doing Business As Name - Organization |
| Street Address |
1129 HARLEM AVE |
| City | FOREST PARK |
| State | IL |
| Zip Code | 60130-2381 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134520620 | Amrita Kaur Rakalla | Dentist | 1129 Harlem Ave, Forest Park, IL 60130-2381 | 2014-09-15 |
| 1528477452 | Paul Edward Difranco | Dentist | 1129 Harlem Ave, Forest Park, IL 60130-2381 | 2014-08-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740828227 | Amanda Ross | Social Worker | 1037 Desplaines Avenue, Unit 607, Forest Park, IL 60130 | 2019-12-16 |
| 1639733959 | Pop Pediatric Therapy Services, LLC | Occupational Therapy Assistant | Pop Pediatric Therapy, 7421 Madison Ave., Forest Park, IL 60130 | 2019-04-23 |
| 1194261776 | Emeryle D Ladd | Driver | 1117 S. Harlem, Unit 1, Forest Park, IL 60130 | 2017-01-06 |
| 1225381106 | Riveredge Hospital | Clinic/Center | 8311 W Roosevelt Road, Forest Park, IL 60130 | 2012-10-17 |
| 1033479712 | Debra L Jensen | Acupuncturist | 7314 W. Madison, Forest Park, IL 60130 | 2012-05-29 |
| 1710289327 | Platinum Dental Care | Health Maintenance Organization | 333 Circle Avenue, Forest Park, IL 60130 | 2010-12-02 |
| 1174857262 | Anwar Adams | Physical Therapy Assistant | 1029 Des Plaines Ave Apt 601, Forest Park, IL 60130 | 2009-09-23 |
| 1992939318 | Family Health Solutions,pc | Chiropractor | 315 Des Plaines Ave., Suite 307, Forest Park, IL 60130 | 2009-05-13 |
| 1235386681 | Arnold Clevs | Dentist | 334 Circle Ave, Forest Park, IL 60130 | 2008-08-27 |
| 1932376167 | Dianella V Dizon-menezes | Psychiatry & Neurology | 8311 W Roosevelt Rd, Advanced Psychiatric Services, Forest Park, IL 60130 | 2008-05-16 |
| Find all providers in zip 60130 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013134154 | Jerry Udelson | Dentist | 1125 Harlem Ave, Forest Park, IL 60130-2337 | 2007-04-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932709433 | Children's Center for Dentistry | Dentist | 314 Susan Dr, Normal, IL 61761-6206 | 2020-10-26 |
| 1073125746 | Jessica Mattern Dds, Pllc | Dentist | 326 W Burlington Ave, La Grange, IL 60525-2363 | 2020-08-23 |
| 1568925014 | Southern Illinois Pediatric Dentistry of Edwardsville | Dentist | 1419 Lewis Road, Suite 2, Edwardsville, IL 62025 | 2019-04-11 |
| 1710450754 | Drs Selberg & Rice Pllc | Dentist | 4945 Stone Falls Ctr Ste B, O Fallon, IL 62269-7801 | 2019-01-02 |
| 1821583634 | Dentalgenix | Dentist | 113 E Schaumburg Rd, Schaumburg, IL 60194-3518 | 2018-06-25 |
| 1528562253 | Rachel Vorwaller | Dentist | 1460 N Halsted St Ste 403, Chicago, IL 60642-2607 | 2018-03-19 |
| 1942740006 | Dhwani M. Joshi | Dentist | 195 S Rand Rd Ste 110, Lake Zurich, IL 60047-2205 | 2017-03-08 |
| 1316393390 | Erin Marie Petrik | Dentist | 2530 N Clark St, Apt 203, Chicago, IL 60614-4972 | 2016-05-10 |
| 1669839593 | Algonquin Kids Dentistry, Inc | Dentist | 4097 W Algonquin Rd, Algonquin, IL 60102-9401 | 2016-01-22 |
| 1720468598 | Mehedia Haque | Dentist | 2062 N Milwaukee Ave, Chicago, IL 60647 | 2015-06-05 |
| Find all providers with the same taxonomy | ||||
| City | FOREST PARK |
| Zip Code | 60130 |
Please comment or provide details below to improve the information on JERRY E UDELSON, DDS, PC.
| 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.