June Upshaw Lallas, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019023799 Issued in IL

Practice address

1200 W State St
Rockford, IL 61102-2112

Phone

(815) 490-1600

Fax

(815) 547-1595

NPI assigned

Nov 23, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• June Elen Upshaw Former name

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Crusaders Central Clinic Association

  • Federally Qualified Health Center (FQHC)
  • Rockford, IL
  • NPI 1902972557
  NPD (past)

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

{
    "created_epoch": "1132704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438300800000",
    "number": "1528041597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 W STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611022112",
            "telephone_number": "815-490-1600",
            "fax_number": "815-547-1595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611022112",
            "telephone_number": "815-490-1600",
            "fax_number": "815-547-1595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LALLAS",
        "first_name": "JUNE",
        "middle_name": "UPSHAW",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-23",
        "last_updated": "2015-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019023799",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019023799",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JUNE",
            "last_name": "UPSHAW",
            "middle_name": "ELEN",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Abigail Diane Lake, DNP, PMHNP-BC
• Lakeshore Clinical LLC
• Lakeside Anesthesiology, S.C
• Lakeside Anesthesiology, SC
• Radhikaben Lakhani
• Gabrielle Lalor, LPC
• Kasondra M Lamere, APRN
• Patricia S Land, COTA
• Kelsey Lane, D.O.
• Lindsay M Lang-Gluscic

• All providers in Rockford, IL
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.