NPIMap

Organization Active NPI

Innovative Pediatric Dentistry

  • Pediatric Dentistry
  • Naperville, IL
National Provider Identifier
1447644802
Registry record updated Mar 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
4744296 Issued in IL
Legal business name
INNOVATIVE PEDIATRIC DENTISTRY
Practice address
55 S Main St Ste 241
Naperville, IL 60540-5377
Phone
(630) 848-2010
Fax
(630) 848-2011
NPI assigned
Mar 24, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2015

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

Authorized official

Name
Dr. Anthony Lavacca, DMD
Title
President
Phone
(630) 848-2010

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 4744296 IL Primary

Addresses

Primary practice location

55 S Main St Ste 241
Naperville, IL 60540-5377

Mailing address

55 S Main St Ste 241
Naperville, IL 60540-5377
Phone (630) 848-2010

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1427155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427155200000",
    "number": "1447644802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 S MAIN ST STE 241",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605405377",
            "telephone_number": "630-848-2010",
            "fax_number": "630-848-2011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 S MAIN ST STE 241",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605405377",
            "telephone_number": "630-848-2010",
            "fax_number": "630-848-2011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-24",
        "last_updated": "2015-03-24",
        "status": "A",
        "authorized_official_last_name": "LAVACCA",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-848-2010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IL",
            "license": "4744296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Naperville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 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.