Active NPI
Ivory Dental
- General Practice Dentistry
- Plainfield, IL
National Provider Identifier
1124549399
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019025824
- Legal business name
- IVORY DENTAL
- Practice address
- 12624 S Route 59
Plainfield, IL 60585-5448 - Phone
- (815) 577-0900
- Fax
- (815) 577-6331
- NPI assigned
- Jun 28, 2017
- Organization subpart
- Yes
- Parent organization
- IVORY DENTAL
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Shefali Patel
- Title
- Owner
- Phone
- (815) 577-0900
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) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019025824 | IL | Primary |
Addresses
Primary practice location
12624 S Route 59
Plainfield, IL 60585-5448
Mailing address
12624 S Route 59
Plainfield, IL 60585-5448
Phone (815) 577-0900
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043387707 | Other | IL | TYPE I |
National Provider Directory
National Provider Directory- Part of
- Ivory Dental
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- General Practice Dentistry
- Plainfield, IL
- NPI 1043387707
-
- Internal Medicine Physician
- Plainfield, IL
- NPI 1154386506
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498608000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1658361600000",
"number": "1124549399",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12624 S ROUTE 59",
"city": "PLAINFIELD",
"state": "IL",
"postal_code": "605855448",
"telephone_number": "815-577-0900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12624 S ROUTE 59",
"city": "PLAINFIELD",
"state": "IL",
"postal_code": "605855448",
"telephone_number": "815-577-0900",
"fax_number": "815-577-6331"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "IVORY DENTAL",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "IVORY DENTAL",
"enumeration_date": "2017-06-28",
"last_updated": "2022-07-21",
"status": "A",
"authorized_official_last_name": "PATEL",
"authorized_official_first_name": "SHEFALI",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "815-577-0900",
"authorized_official_name_prefix": "Dr."
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019025824",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TYPE I",
"identifier": "1043387707",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Plainfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.