Active NPI
Joseph Alan Dougherty, DMD
- Dentist
- New Lenox, IL
National Provider Identifier
1184167363
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- LL-424-16
- Practice address
- 500 Central Rd
New Lenox, IL 60451-3308 - Phone
- (815) 931-1984
- NPI assigned
- Nov 21, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | LL-424-16 | NV | Primary |
Addresses
Primary practice location
500 Central Rd
New Lenox, IL 60451-3308
Mailing address
500 Central Rd
New Lenox, IL 60451-3308
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LL-424-16 | NV | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1479686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1479686400000",
"number": "1184167363",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 CENTRAL RD",
"city": "NEW LENOX",
"state": "IL",
"postal_code": "604513308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 CENTRAL RD",
"city": "NEW LENOX",
"state": "IL",
"postal_code": "604513308",
"telephone_number": "815-931-1984"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGHERTY",
"first_name": "JOSEPH",
"middle_name": "ALAN",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-11-21",
"last_updated": "2016-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NV",
"license": "LL-424-16",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Lenox, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.