The Loose Tooth Pediatric Dentistry

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

019027249 Issued in IL

Legal business name

THE LOOSE TOOTH PEDIATRIC DENTISTRY

Practice address

15041 S Van Dyke Rd
Suite 105
Plainfield, IL 60544-5805

Phone

(815) 267-7299

NPI assigned

Jan 6, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Rhiannon Michelle Holcombe, DDS, MS

Title

Pediatric Dentist

Phone

(815) 267-7299

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1388966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427155200000",
    "number": "1023430360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15041 S VAN DYKE RD",
            "address_2": "SUITE 105",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605445805",
            "telephone_number": "815-267-7299",
            "fax_number": "815-267-7511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15041 S VAN DYKE RD",
            "address_2": "SUITE 105",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605445805",
            "telephone_number": "815-267-7299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LOOSE TOOTH PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-06",
        "last_updated": "2015-03-24",
        "status": "A",
        "authorized_official_last_name": "HOLCOMBE",
        "authorized_official_first_name": "RHIANNON",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "815-267-7299",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IL",
            "license": "019027249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2015; 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.