Fabian David Latocha, D.D.S

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Practice address

202 S Greenleaf St
Suite a
Gurnee, IL 60031-3399

Phone

(847) 623-2830

Fax

(847) 623-1534

NPI assigned

May 4, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 1, 2008 through Oct 1, 2026

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Oral & Maxillofacial Surgeons of Lake County, P.C.

  dba Lake County Oral Surgery

  • Oral and Maxillofacial Pathology Dentistry
  • Gurnee, IL
  • NPI 1023132859
  NPD

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1033167242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13380 W 21ST ST",
            "city": "WADSWORTH",
            "state": "IL",
            "postal_code": "600839474",
            "telephone_number": "847-746-7517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 S GREENLEAF ST",
            "address_2": "SUITE A",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600313399",
            "telephone_number": "847-623-2830",
            "fax_number": "847-623-1534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LATOCHA",
        "first_name": "FABIAN",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lake Shore Gastroenterolgy SC
• Lake Shore Gastroenterology
• Lake Shore Internal Medicine SC (Paru K Sharma)
• Lakeshore Heart & Vascular Specialists
• Rosanna Garcia Lardizabal
• Jennifer Lesley Lawson, MA, LPC
• Joerlyn Josiephine Lazo, DPT
• Christine S Lee, D.D.S.
• Ronald Jordan Lee
• Kelsey E Legagneur, QMHP

• Oral and Maxillofacial Surgery (Dentist) in Gurnee, IL
• Providers in Gurnee, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.