Jon Karl Dively, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

19A13962 Issued in IL

Practice address

4 Doctors LN
Macomb, IL 61455-3376

Phone

(309) 837-3918

NPI assigned

Apr 16, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1659596393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 DOCTORS LN",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614553376",
            "telephone_number": "309-837-3918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 DOCTORS LN",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614553376",
            "telephone_number": "309-837-3918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIVELY",
        "first_name": "JON",
        "middle_name": "KARL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "19A13962",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sabreen Dassa
• David R Culver OD LTD (Family Vision Care)
• Denman Services, Inc (Macomb Medical Equipment & Supply)
• Marilyn Kay Derry
• Rebecca E Derry, MSED, NCC, LCPC
• Diana Brook Dobier, PSYD LCP
• Nicholas D Doll, D.M.D.
• Kaylen Paige Dorich, LCSW
• Dr Eric Botts & Associates LLC
• Kristen Jean Draughan, LCSW

• General Practice Dentistry in Macomb, IL
• Providers in Macomb, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.