Julia R Pesavento, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019-019656 Issued in IL

Practice address

1075 Featherstone Rd Ste 30
Rockford, IL 61107-5906

Phone

(815) 395-1711

Fax

(815) 395-1705

NPI assigned

Apr 16, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

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

• Julia R. Pesavento, D.M.D.

  • General Practice Dentistry
  • Rockford, IL
  • NPI 1083868806
  NPD (past) Authorized official

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590624000000",
    "number": "1043435175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1075 FEATHERSTONE ROAD, SUITE 30",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "61072",
            "telephone_number": "815-395-1711",
            "fax_number": "815-395-1705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 FEATHERSTONE RD STE 30",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075906",
            "telephone_number": "815-395-1711",
            "fax_number": "815-395-1705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PESAVENTO",
        "first_name": "JULIA",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-16",
        "last_updated": "2020-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019-019656",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOCIAL SECURTIY NUMBER",
            "identifier": "$$$$$$$$$",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "019-019656",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jennifer A Petersen, O.T.R.

• General Practice Dentistry in Rockford, IL
• Providers in Rockford, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.