Individual provider Active NPI

Harlan J Rosen, D.D.S.

  • Dentist
  • Joliet, IL
National Provider Identifier
1194894527
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Practice address
3555 W Jefferson St
Joliet, IL 60431-4708
Phone
(815) 741-4155
Fax
(815) 741-4535
NPI assigned
Nov 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X IL Primary

Addresses

Primary practice location

3555 W Jefferson St
Joliet, IL 60431-4708

Mailing address

3555 W Jefferson St
Joliet, IL 60431-4708
Phone (815) 741-4155

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141125000748 IL Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 6608198817

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019-014399ILMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Joliet Smile World Dental Center, Inc. Past Accepting new patients
Tru Dental Illinois, P.C. PastSince Apr 11, 2021 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1194894527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3555 W JEFFERSON ST",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604314708",
            "telephone_number": "815-741-4155",
            "fax_number": "815-741-4535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3555 W JEFFERSON ST",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604314708",
            "telephone_number": "815-741-4155",
            "fax_number": "815-741-4535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSEN",
        "first_name": "HARLAN",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Joliet, IL

Sources for this page

Verify at the official NPI Registry.