Active NPI
Anshuman Soni, DDS
- General Practice Dentistry
- Libertyville, IL
National Provider Identifier
1265415244
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019026289
- Practice address
- 1418 S Milwaukee Ave
Suite # 4
Libertyville, IL 60048 - Phone
- (847) 984-2548
- Fax
- (847) 984-2957
- NPI assigned
- Nov 23, 2005
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019026289 | IL | Primary |
Addresses
Primary practice location
1418 S Milwaukee Ave
Suite # 4
Libertyville, IL 60048
Mailing address
1418 S Milwaukee Ave
Suite # 4
Libertyville, IL 60048
Phone (847) 984-2548
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 019026289 | Other | IL | LICENSE |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019026289 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1444089600000",
"number": "1265415244",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1418 S MILWAUKEE AVE",
"address_2": "SUITE # 4",
"city": "LIBERTYVILLE",
"state": "IL",
"postal_code": "60048",
"telephone_number": "847-984-2548",
"fax_number": "847-984-2957"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1418 S MILWAUKEE AVE",
"address_2": "SUITE # 4",
"city": "LIBERTYVILLE",
"state": "IL",
"postal_code": "60048",
"telephone_number": "847-984-2548",
"fax_number": "847-984-2957"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SONI",
"first_name": "ANSHUMAN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-11-23",
"last_updated": "2015-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019026289",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "019026289",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Libertyville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.