NPIMap

Organization Active NPI

Avid Dental PC

  • General Practice Dentistry
  • Joliet, IL
National Provider Identifier
1083802524
Registry record updated Oct 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
19016647 Issued in IL
Legal business name
AVID DENTAL PC
Practice address
115 Republic Ave
Joliet, IL 60435-6515
Phone
(815) 483-2040
Fax
(815) 483-2071
NPI assigned
Oct 10, 2007
Last updated
Oct 10, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2007

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

Authorized official

Name
Dr. David Joseph Rubis, DDS
Title
President/Owner
Phone
(815) 483-2040

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 19016647 IL Primary

Addresses

Primary practice location

115 Republic Ave
Joliet, IL 60435-6515

Mailing address

115 Republic Ave
Joliet, IL 60435-6515
Phone (815) 483-2040

National Provider Directory

National Provider Directory
Tax ID family
Avid Dental2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1191974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191974400000",
    "number": "1083802524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 REPUBLIC AVE",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604356515",
            "telephone_number": "815-483-2040",
            "fax_number": "815-483-2071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 REPUBLIC AVE",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604356515",
            "telephone_number": "815-483-2040",
            "fax_number": "815-483-2071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVID DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-10",
        "last_updated": "2007-10-10",
        "status": "A",
        "authorized_official_last_name": "RUBIS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "815-483-2040",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "19016647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Joliet, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2007; 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.