NPIMap

Organization Active NPI

Northshore Metropolitan Dental Associates Inc

  • General Practice Dentistry
  • Gurnee, IL
National Provider Identifier
1174651459
Registry record updated Aug 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019025154 Issued in IL
Legal business name
NORTHSHORE METROPOLITAN DENTAL ASSOCIATES INC
Practice address
1790 Nations Dr
Suite 212
Gurnee, IL 60031-9164
Phone
(847) 336-4880
NPI assigned
Mar 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2019

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

Authorized official

Name
Dr. Victor Ka-Tai Lau, D.D.S.NPI 1952381410
Title
President
Phone
(847) 673-6770

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 019025154 IL Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

1790 Nations Dr
Suite 212
Gurnee, IL 60031-9164

Mailing address

1790 Nations Dr
Suite 212
Gurnee, IL 60031-9164
Phone (847) 336-4880

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566777600000",
    "number": "1174651459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1790 NATIONS DR",
            "address_2": "SUITE 212",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600319164",
            "telephone_number": "847-336-4880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1790 NATIONS DR",
            "address_2": "SUITE 212",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600319164",
            "telephone_number": "847-336-4880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSHORE METROPOLITAN DENTAL ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2019-08-26",
        "status": "A",
        "authorized_official_last_name": "LAU",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "KA-TAI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-673-6770",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019025154",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gurnee, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2019; 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.