Active NPI
Holden Danielewicz, DMD
- Dentist
- Libertyville, IL
National Provider Identifier
1023748183
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6001000-15
- Practice address
- 740 Florsheim Dr Ste 12
Libertyville, IL 60048-3712 - Phone
- (847) 350-7718
- NPI assigned
- Jun 13, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019033747 | IL | |
| Dentist | 122300000X | 6001000-15 | WI | Primary |
Addresses
Primary practice location
740 Florsheim Dr Ste 12
Libertyville, IL 60048-3712
Mailing address
740 Florsheim Dr Ste 12
Libertyville, IL 60048-3712
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6001000-15 | WI | MD | Dentist |
| 019033747 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1655078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722816000000",
"number": "1023748183",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "740 FLORSHEIM DR STE 12",
"city": "LIBERTYVILLE",
"state": "IL",
"postal_code": "600483712"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "740 FLORSHEIM DR STE 12",
"city": "LIBERTYVILLE",
"state": "IL",
"postal_code": "600483712",
"telephone_number": "847-350-7718"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DANIELEWICZ",
"first_name": "HOLDEN",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-06-13",
"last_updated": "2024-08-05",
"certification_date": "2024-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019033747",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "6001000-15",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Libertyville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.