NPIMap

Organization Active NPI

Dental Professionals of Illinois, P.C.

  • General Practice Dentistry
  • North Aurora, IL
National Provider Identifier
1609053206
Registry record updated Jul 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
DENTAL PROFESSIONALS OF ILLINOIS, P.C.
Practice address
100 Hansen Blvd
North Aurora, IL 60542-8985
Phone
(630) 896-3939
Fax
(630) 896-3997
NPI assigned
Jan 25, 2008
Organization subpart
Yes
Parent organization
DENTAL PROFESSIONALS OF ILLINOIS, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 31, 2023

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

Authorized official

Name
Hannah Fish
Title
Credentialing Manager
Phone
(217) 540-5699

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

100 Hansen Blvd
North Aurora, IL 60542-8985

Mailing address

100 Hansen Blvd
North Aurora, IL 60542-8985
Phone (630) 896-3939

Other names 1

  • North Aurora Lifetime Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dental Professionals of Illinois PC75 organizations share this tax ID, including this one
Part of
Dental Professionals of Illinois PC

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

100 Hansen Blvd
North Aurora, IL 60542
Phone (630) 896-3939

Practitioners & affiliated clinicians

Practitioners 2

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": "1201219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690761600000",
    "number": "1609053206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 HANSEN BLVD",
            "city": "NORTH AURORA",
            "state": "IL",
            "postal_code": "605428985",
            "telephone_number": "630-896-3939",
            "fax_number": "630-896-3997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HANSEN BLVD",
            "city": "NORTH AURORA",
            "state": "IL",
            "postal_code": "605428985",
            "telephone_number": "630-896-3939",
            "fax_number": "630-896-3997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PROFESSIONALS OF ILLINOIS, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL PROFESSIONALS OF ILLINOIS, P.C.",
        "enumeration_date": "2008-01-25",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-31",
        "status": "A",
        "authorized_official_last_name": "FISH",
        "authorized_official_first_name": "HANNAH",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "217-540-5699"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Aurora Lifetime Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Aurora, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2023; 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.