Innovative Dental Management

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019025474 Issued in IL

Legal business name

INNOVATIVE DENTAL MANAGEMENT

Practice address

2246 E Grand Ave
Lindenhurst, IL 60046-7522

Phone

(847) 265-6444

Fax

(847) 264-6464

NPI assigned

Dec 16, 2009

Organization subpart

No

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

Authorized official

Name

Mr. Raja Goel

Title

Business Owner

Phone

(847) 265-6444

Specialties & licenses 2

Addresses

Other names 1

• Great Lakes Dental Other name

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

{
    "created_epoch": "1260921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260921600000",
    "number": "1295064541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2246 E GRAND AVE",
            "city": "LINDENHURST",
            "state": "IL",
            "postal_code": "600467522",
            "telephone_number": "847-265-6444",
            "fax_number": "847-264-6464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2246 E GRAND AVE",
            "city": "LINDENHURST",
            "state": "IL",
            "postal_code": "600467522",
            "telephone_number": "847-265-6444",
            "fax_number": "847-264-6464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE DENTAL MANAGEMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-16",
        "last_updated": "2009-12-16",
        "status": "A",
        "authorized_official_last_name": "GOEL",
        "authorized_official_first_name": "RAJA",
        "authorized_official_title_or_position": "BUSINESS OWNER",
        "authorized_official_telephone_number": "847-265-6444",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019025474",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019025462",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Lakes Dental",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Eden Horigan
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• Image Dentistry
• Nancy E Jaffe, MA CCC-SLP
• James P. Orticelli, D.D.S.
• Kristian L James
• Jay a Wygodny DMD PC
• JLDC Inc.

• All providers in Lindenhurst, IL
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2009; 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.