Daniel Louis Jaconetti, DDS
Individual provider Active NPI General Practice Dentistry · Norridge, IL
NPI 1649336702 · NPPES record last updated Apr 15, 2014
Key facts
- NPI
- 1649336702
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 019-018380 (IL)
- Practice address
- 7601 W Montrose Ave
Suite 3
Norridge, IL 60706-1000 - Phone
- (708) 453-8700
- Fax
- (708) 453-1564
- NPI assigned
- Dec 30, 2006
- Reactivated
- Mar 3, 2014
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151229001428 | IL | Order and Referring Only - Oral Surgery |
9133420607 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019-018380 | IL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Daniel L. Jaconetti DDS LTD | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019-018380 | IL | Yes |
Addresses
Primary practice location
7601 W Montrose Ave
Suite 3
Norridge, IL 60706-1000
Mailing address
7601 W Montrose Ave
Suite 3
Norridge, IL 60706-1000
Phone (708) 453-8700
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All providers in Norridge, IL · General Practice Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 15, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.