NPIMap

Organization Active NPI

Lonn E Brander DDS LTD

  • Dentist
  • Rockford, IL
National Provider Identifier
1477975175
Registry record updated Sep 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019-022322 Issued in IL
Legal business name
LONN E BRANDER DDS LTD
Practice address
5668 E State St
Suite 1100
Rockford, IL 61108-2490
Phone
(815) 977-5281
Fax
(815) 977-5361
NPI assigned
Jan 15, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2014

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

Authorized official

Name
Dr. Lonn Edward Brander, DDSNPI 1972639284
Title
Owner
Phone
(815) 756-2295

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 019-022322 IL Primary
Customized Equipment (DME) 332BC3200X

Addresses

Primary practice location

5668 E State St
Suite 1100
Rockford, IL 61108-2490

Mailing address

5668 E State St
Suite 1100
Rockford, IL 61108-2490
Phone (815) 977-5281

Other names 1

  • Brander Sleep Wellness Ltd. Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140324000858 IL DME Supplier - Oral Surgery - Dentist 9032340773 Practice locations: Rockford, IL

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Brander Dental Care Sleep Wellness2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5668 E State St
Ste 1100
Rockford, IL 61108
Phone (815) 977-5281

2550 Hauser Ross Dr
Ste 300
Sycamore, IL 60178
Phone (815) 756-2295

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1389744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410134400000",
    "number": "1477975175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5668 E STATE ST",
            "address_2": "SUITE 1100",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082490",
            "telephone_number": "815-977-5281",
            "fax_number": "815-977-5361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5668 E STATE ST",
            "address_2": "SUITE 1100",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082490",
            "telephone_number": "815-977-5281",
            "fax_number": "815-977-5361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONN E BRANDER DDS LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-15",
        "last_updated": "2014-09-08",
        "status": "A",
        "authorized_official_last_name": "BRANDER",
        "authorized_official_first_name": "LONN",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-756-2295",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019-022322",
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brander Sleep Wellness Ltd.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rockford, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.