Illinois Valley Endodontics LLC

Primary specialty

EndodonticsTaxonomy code 1223E0200X

Legal business name

ILLINOIS VALLEY ENDODONTICS LLC

Doing business as

Lee M. Ceresa DDS

Practice address

1601 4TH St
Peru, IL 61354-3507

Phone

(815) 224-3636

Fax

(815) 220-1479

NPI assigned

Jan 9, 2008

Last updated

Jan 9, 2008By 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. Lee Michael Ceresa, DDSNPI 1063513117

Title

Owner/Dentist

Phone

(815) 224-3636

Specialties & licenses 1

Addresses

Other names 1

• Lee M. Ceresa DDS Doing business as

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.

• Lee Michael Ceresa, D.D.S.

  • Endodontics
  • Peru, IL
  • NPI 1063513117
  NPD (past) Authorized official

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

{
    "created_epoch": "1199836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199836800000",
    "number": "1407031305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 4TH ST",
            "city": "PERU",
            "state": "IL",
            "postal_code": "613543507",
            "telephone_number": "815-224-3636",
            "fax_number": "815-220-1479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 4TH ST",
            "city": "PERU",
            "state": "IL",
            "postal_code": "613543507",
            "telephone_number": "815-224-3636",
            "fax_number": "815-220-1479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS VALLEY ENDODONTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-09",
        "last_updated": "2008-01-09",
        "status": "A",
        "authorized_official_last_name": "CERESA",
        "authorized_official_first_name": "LEE",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "815-224-3636",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lee M. Ceresa DDS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Kleven H Israelsen, D.O.
• J a K Enterprises Inc (Bard Optical)

• Endodontics in Peru, IL
• Providers in Peru, IL by specialty
• Endodontics in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2008; 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.