John Phillip Lavieri, DDS
Individual provider Active NPI Oral and Maxillofacial Surgery (Dentist) · La Salle, IL
NPI 1467546689 · NPPES record last updated Apr 4, 2008
Key facts
- NPI
- 1467546689
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist) 1223S0112X
- Practice address
- 206 Marquette Street
Suite 311
La Salle, IL 61301-2483 - Phone
- (815) 224-1988
- Fax
- (815) 224-3220
- NPI assigned
- Oct 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080827000478 | IL | Practitioner - Maxillofacial Surgery |
0840366860 | Practice locations: La Salle, IL |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021001234 OMS LICENS | IL | MD | Oral and Maxillofacial Surgery (Dentist) |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | IL | Yes | |
| Oral & Maxillofacial Surgery (D.M.D.) | 204E00000X | IL |
Addresses
Primary practice location
206 Marquette Street
Suite 311
La Salle, IL 61301-2483
Mailing address
206 Marquette Street
Suite 311
La Salle, IL 61301-2483
Phone (815) 224-1988
Other names
- Dr. John Phillip Lavieri Jr.
Other providers in La Salle, IL
- Lexi Kerr
- Juliann Kersten
- Ronda Ketner
- Lasalle Peru TWP HS Dist 120
- Lasalle Public Elem 122
- Sarah Lavieri
- Jennifer N Leonard
- Life Balance Counseling and Wellness Inc
- Local NP PC
- David Lee Martin
All providers in La Salle, IL · Oral and Maxillofacial Surgery (Dentist) in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 4, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.