NPIMap

Organization Active NPI

Lakemoor Dental

  • Dentist
  • Lakemoor, IL
National Provider Identifier
1356719603
Registry record updated Sep 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019023300 Issued in IL
Legal business name
LAKEMOOR DENTAL
Practice address
28956 W. RT 120
Lakemoor, IL 60051
Phone
(815) 363-8888
Fax
(815) 363-8890
NPI assigned
Sep 3, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2015

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

Authorized official

Name
Dr. Sima R Patel, D.D.S.NPI 1699975409
Title
Dentist
Phone
(815) 363-8888

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
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 019023300 IL Primary

Addresses

Primary practice location

28956 W. RT 120
Lakemoor, IL 60051

Mailing address

28956 W. RT 120
Lakemoor, IL 60051
Phone (815) 363-8888

National Provider Directory

National Provider Directory

Locations

28956 W State Route 120
Lakemoor, IL 60051
Phone (815) 363-8888

Practitioners & affiliated clinicians

Practitioners 5

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": "1441238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441238400000",
    "number": "1356719603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28956 W. RT 120",
            "city": "LAKEMOOR",
            "state": "IL",
            "postal_code": "60051",
            "telephone_number": "815-363-8888",
            "fax_number": "815-363-8890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28956 W. RT 120",
            "city": "LAKEMOOR",
            "state": "IL",
            "postal_code": "60051",
            "telephone_number": "815-363-8888",
            "fax_number": "815-363-8890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEMOOR DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-03",
        "last_updated": "2015-09-03",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "SIMA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "815-363-8888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019023300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakemoor, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 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.

Verify at the official NPI Registry.