Jason Ralph Crescenzo, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019027570 Issued in IL

Practice address

16345 Harlem Ave Ste 160
Tinley Park, IL 60477-2589

Phone

(708) 781-9754

Fax

(708) 781-9758

NPI assigned

Apr 23, 2008

Last updated

Feb 2, 2011By 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Jason R. Crescenzo, DDS, P.C.

  dba Aesthetic Family Dental of Tinley Park

  • Dental Clinic/Center
  • Tinley Park, IL
  • NPI 1629374046
  NPD (past) Authorized official

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

{
    "created_epoch": "1208908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296604800000",
    "number": "1114192838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16345 HARLEM AVE STE 160",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604772589",
            "telephone_number": "708-781-9754",
            "fax_number": "708-781-9758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16345 HARLEM AVE STE 160",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604772589",
            "telephone_number": "708-781-9754",
            "fax_number": "708-781-9758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRESCENZO",
        "first_name": "JASON",
        "middle_name": "RALPH",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-23",
        "last_updated": "2011-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019027570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Tinley Park, IL
• Providers in Tinley Park, 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 Feb 2, 2011; 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.