NPIMap

Organization Active NPI

Sycamore Family Dentistry, LTD.

  • Dentist
  • Sycamore, IL
National Provider Identifier
1104011808
Registry record updated Sep 6, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
SYCAMORE FAMILY DENTISTRY, LTD.
Practice address
645 Plaza Dr
Sycamore, IL 60178-2719
Phone
(815) 895-2298
NPI assigned
Sep 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2007

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

Authorized official

Name
Dr. Joseph T Sullivan, DDSNPI 1487771135
Title
Owner/Dentist
Phone
(815) 895-2298

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X IL Primary

Addresses

Primary practice location

645 Plaza Dr
Sycamore, IL 60178-2719

Mailing address

645 Plaza Dr
Sycamore, IL 60178-2719
Phone (815) 895-2298

National Provider Directory

National Provider Directory

Locations

645 Plaza Dr
Sycamore, IL 60178
Phone (815) 895-2298

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1189036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189036800000",
    "number": "1104011808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 PLAZA DR",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601782719",
            "telephone_number": "815-895-2298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 PLAZA DR",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601782719",
            "telephone_number": "815-895-2298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYCAMORE FAMILY DENTISTRY, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-06",
        "last_updated": "2007-09-06",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "815-895-2298",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sycamore, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 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.