NPIMap

Organization Active NPI

Great Lakes Dental P.C.

Doing business as Great Lakes Dental Solutions

  • Dental Clinic/Center
  • Libertyville, IL
National Provider Identifier
1447657234
Registry record updated Dec 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
019026289 Issued in IL
Legal business name
GREAT LAKES DENTAL P.C.
Doing business as
Great Lakes Dental Solutions
Practice address
1418 S Milwaukee Ave
Suite 4
Libertyville, IL 60048-3796
Phone
(815) 209-6272
NPI assigned
Nov 23, 2014
Last updated
Dec 16, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2014

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

Authorized official

Name
Dr. Anshuman Soni, DDSNPI 1265415244
Title
President / Dentist
Phone
(815) 209-6272

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 019026289 IL Primary

Addresses

Primary practice location

1418 S Milwaukee Ave
Suite 4
Libertyville, IL 60048-3796

Mailing address

1418 S Milwaukee Ave
Suite 4
Libertyville, IL 60048-3796

Other identifiers 2

IdentifierTypeStateIssuer
9176879MedicaidIL
1265415244OtherILNPI 1

Other names 1

  • Great Lakes Dental Solutions Doing business as

National Provider Directory

National Provider Directory

Locations

1418 S Milwaukee Ave
Ste 4
Libertyville, IL 60048
Phone (815) 209-6272

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1416700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418688000000",
    "number": "1447657234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1418 S MILWAUKEE AVE",
            "address_2": "SUITE 4",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600483796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1418 S MILWAUKEE AVE",
            "address_2": "SUITE 4",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600483796",
            "telephone_number": "815-209-6272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES DENTAL P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-23",
        "last_updated": "2014-12-16",
        "status": "A",
        "authorized_official_last_name": "SONI",
        "authorized_official_first_name": "ANSHUMAN",
        "authorized_official_title_or_position": "PRESIDENT / DENTIST",
        "authorized_official_telephone_number": "815-209-6272",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": "019026289",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9176879",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI 1",
            "identifier": "1265415244",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Lakes Dental Solutions",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Libertyville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2014; 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.