NPIMap

Organization Active NPI

Swan Dental P.C.

  • Dentist
  • Round Lake Beach, IL
National Provider Identifier
1588086946
Registry record updated Jan 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019028736 Issued in IL
Legal business name
SWAN DENTAL P.C.
Practice address
23 W Rollins Rd
Round Lake Beach, IL 60073-1350
Phone
(847) 740-4600
NPI assigned
Jan 19, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2014

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

Authorized official

Name
Siddharth Bansal, DMD
Title
Secretary
Phone
(352) 872-8066

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 019028736 IL Primary

Addresses

Primary practice location

23 W Rollins Rd
Round Lake Beach, IL 60073-1350

Mailing address

1460 S Peoria St
Chicago, IL 60608-2208
Phone (352) 872-8066

Other names 1

  • Avon Dental P.C. Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1390089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390089600000",
    "number": "1588086946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1460 S PEORIA ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606082208",
            "telephone_number": "352-872-8066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 W ROLLINS RD",
            "city": "ROUND LAKE BEACH",
            "state": "IL",
            "postal_code": "600731350",
            "telephone_number": "847-740-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SWAN DENTAL P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-19",
        "last_updated": "2014-01-19",
        "status": "A",
        "authorized_official_last_name": "BANSAL",
        "authorized_official_first_name": "SIDDHARTH",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "352-872-8066",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019028736",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avon Dental P.C.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Round Lake Beach, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 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.