NPIMap

Organization Active NPI

Naperville Dental Group

  • General Practice Dentistry
  • Naperville, IL
National Provider Identifier
1669865135
Registry record updated Mar 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019.017904 Issued in IL
Legal business name
NAPERVILLE DENTAL GROUP
Practice address
1020 E Ogden Ave
Suite 308
Naperville, IL 60563-8609
Phone
(630) 527-0544
Fax
(630) 527-2433
NPI assigned
Mar 9, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2015

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

Authorized official

Name
Dr. Kenneth R. Pickett, D.D.S.NPI 1396884599
Title
President/Business Owner
Phone
(630) 527-0544

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 019.017904 IL
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 019.029826 IL
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 019.017904 IL Primary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 019.029826 IL
PeriodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0300X 021.001252 IL

Addresses

Primary practice location

1020 E Ogden Ave
Suite 308
Naperville, IL 60563-8609

Mailing address

1020 E Ogden Ave
Suite 308
Naperville, IL 60563-8609
Phone (630) 527-0544

National Provider Directory

National Provider Directory

Locations

1020 E Ogden Ave
Ste 308
Naperville, IL 60563
Phone (630) 527-0544

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": "1425859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425859200000",
    "number": "1669865135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 E OGDEN AVE",
            "address_2": "SUITE 308",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605638609",
            "telephone_number": "630-527-0544",
            "fax_number": "630-527-2433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 E OGDEN AVE",
            "address_2": "SUITE 308",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605638609",
            "telephone_number": "630-527-0544",
            "fax_number": "630-527-2433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NAPERVILLE DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-09",
        "last_updated": "2015-03-09",
        "status": "A",
        "authorized_official_last_name": "PICKETT",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT/BUSINESS OWNER",
        "authorized_official_telephone_number": "630-527-0544",
        "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": "019.017904",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.029826",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.017904",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.029826",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": "021.001252",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Naperville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2015; 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.