Island Lake Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

ISLAND LAKE DENTAL LLC

Practice address

510 Auburn Dr Ste D
Island Lake, IL 60042-9105

Phone

(630) 765-1762

NPI assigned

Jan 23, 2024

Last updated

Jan 23, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Nikhar Shah, DMDNPI 1336615186

Title

President

Phone

(630) 765-1762

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nikhar D Shah

  • General Practice Dentistry
  • Rockford, IL
  • NPI 1336615186
  NPD Authorized official

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

{
    "created_epoch": "1705968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705968000000",
    "number": "1376304626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "232 STONINGTON DR",
            "city": "BLOOMINGDALE",
            "state": "IL",
            "postal_code": "601087810",
            "telephone_number": "630-765-1762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 AUBURN DR STE D",
            "city": "ISLAND LAKE",
            "state": "IL",
            "postal_code": "600429105",
            "telephone_number": "630-765-1762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND LAKE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-23",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "NIKHAR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-765-1762",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gretchel Freeman
• Gentle Dental of Island Lake LTD
• Gurbax Singh Saini MD
• Katelyn Marie Hageman, DC
• Hope Counseling of Wauconda, P.C.
• Island Lake Urgent Care Inc
• J. Lynn James, LCPC
• Cynthia Evans Johnson, L.M.T.
• Michael Kuk, PHARMD
• Lake Immediate Care & Clinic S C

• General Practice Dentistry in Island Lake, IL
• Providers in Island Lake, 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 Jan 23, 2024; 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.