Unknown Individual – General Practice Dentistry, NPI 1104071166

General Practice Dentistry

Unknown Individual is a healthcare provider. based in Itasca, Illinois. specializing in General Practice Dentistry. They hold a License No. 019-011920 (IL). The NPI Number for Unknown Individual is 1104071166

Main info

Organization

Inactive

Name

Unknown Individual

NPI

1104071166

Phone

(630) 773-2395

Address

115 W ORCHARD ST.

Deactivation Date

1 April 2022

Data current as of

20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness75

Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

115, West Orchard Street, Itasca, DuPage County, Illinois, 60143, United States
ITASCA, IL 60143
Phone: (630) 773-2395
Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 60143)

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Reviews

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Frequently asked questions

What number should I use to identify Unknown Individual for billing?

Administrative and clinical systems typically use NPI 1104071166 for Unknown Individual.

What happens when Unknown Individual's NPI is not active?

Public data lists Unknown Individual outside the active bucket for this identifier.

Which specialty label fits Unknown Individual?

NPPES ties Unknown Individual to General Practice Dentistry in the taxonomy section. Clinical services aligned with this taxonomy classification.

Which community is linked to Unknown Individual?

Unknown Individual shows a connection to Itasca, Illinois in registry-derived data.

Can I export Unknown Individual's record?

You can download the official NPPES record; we summarize key fields for readability.

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