PERIODONTAL MEDICINE AND SURGICAL SPECIALISTS, LLC – NPI #1811036718
Clinic/Center

PERIODONTAL MEDICINE AND SURGICAL SPECIALISTS, LLC is an AHC clinic located in OAKBROOK TERRACE, IL. NPPES has assigned the NPI number 1811036718 to PERIODONTAL MEDICINE AND SURGICAL SPECIALISTS, LLC on February 06, 2007. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The former legal business name for this organization is PERIODONTAL MEDICINE AND SURGICAL SPECIALISTS, LTD. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 261QD0000X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Dental

The NPI profile was previously updated about 9 years ago on Dec 16, 2016. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for PERIODONTAL MEDICINE AND SURGICAL SPECIALISTS, LLC below.

NPI Profile for
PERIODONTAL MEDICINE AND SURGICAL SPECIALISTS, LLC

NPI Number
1811036718
Enumeration Date

(more than 19 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
PERIODONTAL MEDICINE AND SURGICAL SPECIALISTS, LLC
Former Legal Business Name: PERIODONTAL MEDICINE AND SURGICAL SPECIALISTS, LTD
Primary location
1S224 SUMMIT AVE
SUITE 205
OAKBROOK TERRACE, IL 60181-3983
Phone: (630) 627-3930 Fax: (630) 627-2148
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
GEORGE MANDELARIS
OWNER PERIODONTIST
Phone: (630) 627-3930
Updated
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QD0000X
- Clinic/Center / Dental (Primary)		 IL 060-003629
1223P0300X
- Dentist / Periodontics		 IL 019030200

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.