NPIMap

Organization Active NPI

Lincoln Way Family Dental, P.C.

  • Dentist
  • Mokena, IL
National Provider Identifier
1588948129
Registry record updated Sep 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019-026473 Issued in IL
Legal business name
LINCOLN WAY FAMILY DENTAL, P.C.
Practice address
11238 Lincoln Hwy
Mokena, IL 60448-8208
Phone
(815) 469-4009
NPI assigned
Sep 30, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2011

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

Authorized official

Name
Robert Davis, DMD
Title
Owner/Dentist
Phone
(815) 469-4009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 019-026473 IL Primary

Addresses

Primary practice location

11238 Lincoln Hwy
Mokena, IL 60448-8208

Mailing address

11238 Lincoln Hwy
Mokena, IL 60448-8208
Phone (815) 469-4009

National Provider Directory

National Provider Directory

Locations

11238 Lincoln Hwy
Mokena, IL 60448
Phone (815) 469-4009

NPI Registry JSON

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

{
    "created_epoch": "1317340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317340800000",
    "number": "1588948129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11238 LINCOLN HWY",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604488208",
            "telephone_number": "815-469-4009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11238 LINCOLN HWY",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604488208",
            "telephone_number": "815-469-4009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINCOLN WAY FAMILY DENTAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-30",
        "last_updated": "2011-09-30",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "815-469-4009",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019-026473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mokena, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2011; 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.