NPIMap

Organization Active NPI

Dental Health and Beauty

  • General Practice Dentistry
  • Libertyville, IL
National Provider Identifier
1265728224
Registry record updated Jun 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019.018686 Issued in IL
Legal business name
DENTAL HEALTH AND BEAUTY
Practice address
1109 W Park Ave
Libertyville, IL 60048-2552
Phone
(847) 367-1133
Fax
(847) 367-3388
NPI assigned
Jun 28, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2011

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

Authorized official

Name
Dr. Nicholas Polito, DDSNPI 1114001302
Title
Owner
Phone
(847) 361-1133

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 019.018686 IL Primary

Addresses

Primary practice location

1109 W Park Ave
Libertyville, IL 60048-2552

Mailing address

1109 W Park Ave
Libertyville, IL 60048-2552
Phone (847) 367-1133

National Provider Directory

National Provider Directory

Locations

1109 W Park Ave
Libertyville, IL 60048
Phone (847) 367-1133

Practitioners & affiliated clinicians

Practitioners 3

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": "1309219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309219200000",
    "number": "1265728224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1109 W PARK AVE",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600482552",
            "telephone_number": "847-367-1133",
            "fax_number": "847-367-3388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 W PARK AVE",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600482552",
            "telephone_number": "847-367-1133",
            "fax_number": "847-367-3388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL HEALTH AND BEAUTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-28",
        "last_updated": "2011-06-28",
        "status": "A",
        "authorized_official_last_name": "POLITO",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-361-1133",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.018686",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Jun 28, 2011; 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.