NPIMap

Organization Active NPI

Lagrange Dental Management

  • General Practice Dentistry
  • La Grange Park, IL
National Provider Identifier
1013151901
Registry record updated Apr 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019022779 Issued in IL
Legal business name
LAGRANGE DENTAL MANAGEMENT
Practice address
342 Sherwood Rd
La Grange Park, IL 60526-1967
Phone
(708) 482-4610
Fax
(708) 482-0246
NPI assigned
Apr 23, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jonathan Villanueva
Title
Practice Manager
Phone
(630) 324-6749

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 019022779 IL Primary

Addresses

Primary practice location

342 Sherwood Rd
La Grange Park, IL 60526-1967

Mailing address

342 Sherwood Rd
La Grange Park, IL 60526-1967
Phone (708) 482-4610

National Provider Directory

National Provider Directory

Locations

342 Sherwood Rd
La Grange Park, IL 60526
Phone (708) 482-4610

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1240444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240444800000",
    "number": "1013151901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "342 SHERWOOD RD",
            "city": "LA GRANGE PARK",
            "state": "IL",
            "postal_code": "605261967",
            "telephone_number": "708-482-4610",
            "fax_number": "708-482-0246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "342 SHERWOOD RD",
            "city": "LA GRANGE PARK",
            "state": "IL",
            "postal_code": "605261967",
            "telephone_number": "708-482-4610",
            "fax_number": "708-482-0246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAGRANGE DENTAL MANAGEMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-23",
        "last_updated": "2009-04-23",
        "status": "A",
        "authorized_official_last_name": "VILLANUEVA",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "630-324-6749",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019022779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Grange Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.