Heritage Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

HERITAGE DENTAL

Practice address

800 Main St
Antioch, IL 60002-1542

Phone

(847) 395-1461

Fax

(847) 395-9255

NPI assigned

Jan 8, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Kenneth Jazdzewski, DDS

Title

Officer of Corporation

Phone

(847) 395-1461

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1356490700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 MAIN ST",
            "city": "ANTIOCH",
            "state": "IL",
            "postal_code": "600021542",
            "telephone_number": "847-395-1461",
            "fax_number": "847-395-9255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 MAIN ST",
            "city": "ANTIOCH",
            "state": "IL",
            "postal_code": "600021542",
            "telephone_number": "847-395-1461",
            "fax_number": "847-395-9255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JAZDZEWSKI",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "OFFICER OF CORPORATION",
        "authorized_official_telephone_number": "847-395-1461",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Neil Jay Harwicke, PH.D.
• Shirley Hawkins, LCSW
• Michael Heard, LCSW
• Pauravi Hefner
• Kimberly Henrichs
• David E Herman, MD
• Shannon Marie Herman, PHARM D
• Highland Park CVS, L.L.C.
• Jimmi Devang Hingu, PTA
• Robin Ann Holmer

• General Practice Dentistry in Antioch, IL
• Providers in Antioch, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.