Vaughn De Guzman, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019025867 Issued in IL

Practice address

5640 Clayton Cir
Roscoe, IL 61073-9503

Phone

(815) 623-7366

Fax

(815) 623-7331

NPI assigned

Nov 28, 2007

Last updated

Nov 28, 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

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

State licenses

Practice roles

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.

• Roscoe Family Dental Center, P.C.

  • General Practice Dentistry
  • Roscoe, IL
  • NPI 1780839837
  NPD (past) Authorized official

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

{
    "created_epoch": "1196208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196208000000",
    "number": "1104008515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5640 CLAYTON CIR",
            "city": "ROSCOE",
            "state": "IL",
            "postal_code": "610739503",
            "telephone_number": "815-623-7366",
            "fax_number": "815-623-7331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5640 CLAYTON CIR",
            "city": "ROSCOE",
            "state": "IL",
            "postal_code": "610739503",
            "telephone_number": "815-623-7366",
            "fax_number": "815-623-7331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE GUZMAN",
        "first_name": "VAUGHN",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-28",
        "last_updated": "2007-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019025867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gayle R Crays, MD
• Marlena Dagostin
• Jordan Marie Dahlberg, FNP-BC
• Daniel L Syverson DPM
• Day One Counseling, PLLC
• Tamara S Dean, LSW
• Jamilyn Louise Desanti, MSW, LSW
• Angela Didomenico
• Cody Allen Digiovanni, PT
• Natalie Dileonardo, MD

• General Practice Dentistry in Roscoe, IL
• Providers in Roscoe, 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 Nov 28, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.