Healthy Tooth Dental, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019027665 Issued in IL

Legal business name

HEALTHY TOOTH DENTAL, LLC

Practice address

719 Lake St
Oak Park, IL 60301-1406

Phone

(708) 386-3200

Fax

(708) 386-3206

NPI assigned

Sep 21, 2009

Last updated

Dec 3, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Edward D Lopez

Title

President

Phone

(708) 386-3200

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Amy Katherine Rodriguez, D.D.S

  • Dentist
  • Oak Park, IL
  • NPI 1447486618
  NPD (past)

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

{
    "created_epoch": "1253491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386028800000",
    "number": "1669706800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "719 LAKE ST",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011406",
            "telephone_number": "708-386-3200",
            "fax_number": "708-386-3206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 LAKE ST",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011406",
            "telephone_number": "708-386-3200",
            "fax_number": "708-386-3206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHY TOOTH DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-21",
        "last_updated": "2013-12-03",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-386-3200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019027665",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1861651622",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2013; 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.