NPIMap

Organization Active NPI

Fairfield Dental

  • Dentist
  • Round Lake, IL
National Provider Identifier
1629347497
Registry record updated Dec 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019023746 Issued in IL
Legal business name
FAIRFIELD DENTAL
Practice address
732 N Fairfield Rd
Round Lake, IL 60073-8160
Phone
(847) 740-4100
NPI assigned
Dec 22, 2011
Organization subpart
Yes
Parent organization
LAWRENCE DENTAL GROUP, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 22, 2011

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

Authorized official

Name
Dr. George Korovilas, D.D.S.NPI 1043381726
Title
President
Phone
(773) 740-4100

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 019023746 IL Primary

Addresses

Primary practice location

732 N Fairfield Rd
Round Lake, IL 60073-8160

Mailing address

3607 W Lawrence Ave
Chicago, IL 60625-5605
Phone (773) 588-7660

National Provider Directory

National Provider Directory
Tax ID family
Fairfield Dental2 organizations share this tax ID, including this one
Part of
Fairfield Dental

Other organizations with this tax ID 1

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

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": "1324512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324512000000",
    "number": "1629347497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3607 W LAWRENCE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606255605",
            "telephone_number": "773-588-7660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "732 N FAIRFIELD RD",
            "city": "ROUND LAKE",
            "state": "IL",
            "postal_code": "600738160",
            "telephone_number": "847-740-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRFIELD DENTAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAWRENCE DENTAL GROUP, P.C.",
        "enumeration_date": "2011-12-22",
        "last_updated": "2011-12-22",
        "status": "A",
        "authorized_official_last_name": "KOROVILAS",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-740-4100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019023746",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Round Lake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 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.