NPIMap

Organization Active NPI

Dental on 45 Inc

  • Dentist
  • Third Lake, IL
National Provider Identifier
1184033839
Registry record updated Aug 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
DENTAL ON 45 INC
Practice address
34484 N US Highway 45
Suite C
Third Lake, IL 60030-4038
Phone
(224) 541-4066
Fax
(847) 752-8425
NPI assigned
Aug 7, 2014
Last updated
Aug 7, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2014

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

Authorized official

Name
Mrs. Marlen Fajardo
Title
Office Manager
Phone
(224) 541-4066

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

34484 N US Highway 45
Suite C
Third Lake, IL 60030-4038

Mailing address

34484 N US Highway 45
Suite C
Third Lake, IL 60030-4038
Phone (224) 541-4066

National Provider Directory

National Provider Directory
Tax ID family
Dental on 45 Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1407369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407369600000",
    "number": "1184033839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34484 N US HIGHWAY 45",
            "address_2": "SUITE C",
            "city": "THIRD LAKE",
            "state": "IL",
            "postal_code": "600304038",
            "telephone_number": "224-541-4066",
            "fax_number": "847-752-8425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34484 N US HIGHWAY 45",
            "address_2": "SUITE C",
            "city": "THIRD LAKE",
            "state": "IL",
            "postal_code": "600304038",
            "telephone_number": "224-541-4066",
            "fax_number": "847-752-8425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL ON 45 INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-07",
        "last_updated": "2014-08-07",
        "status": "A",
        "authorized_official_last_name": "FAJARDO",
        "authorized_official_first_name": "MARLEN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "224-541-4066",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Third Lake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2014; 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.