Libertyville Pediatric Dentistry

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

LIBERTYVILLE PEDIATRIC DENTISTRY

Practice address

1870 W Winchester Rd Ste 143
Libertyville, IL 60048-5359

Phone

(630) 854-6044

NPI assigned

Dec 12, 2023

Organization subpart

No

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

Authorized official

Name

Bianca Hassoun, DMDNPI 1760902654

Title

Operator

Phone

(630) 854-6044

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bianca Anne Hassoun

  • Pediatric Dentistry
  • Kenosha, WI
  • NPI 1760902654
  NPD Authorized official

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

{
    "created_epoch": "1702339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702339200000",
    "number": "1043088784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1870 W WINCHESTER RD STE 143",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600485359",
            "telephone_number": "630-854-6044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1870 W WINCHESTER RD STE 143",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600485359",
            "telephone_number": "630-854-6044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTYVILLE PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-12",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A",
        "authorized_official_last_name": "HASSOUN",
        "authorized_official_first_name": "BIANCA",
        "authorized_official_title_or_position": "OPERATOR",
        "authorized_official_telephone_number": "630-854-6044",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Libertyville Manor
• Libertyville Manor Extended Care Facility, Inc.
• Libertyville Neurosurgery, LLC
• Libertyville OBGYN S.C.
• Libertyville Oral Surgery PC
• Libertyville Podiatry
• Libertyville Podiatry PC
• Libertyville School District #70
• Libertyville Skilled Nursing Facility LLC
• Libertyville Wellness Group, Inc

• Dental Clinic/Center in Libertyville, IL
• Providers in Libertyville, IL by specialty
• Dental Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2023; 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.