NPIMap

Organization Active NPI

Hamilton Lakes Dentistry

  • Dentist
  • Itasca, IL
National Provider Identifier
1700938412
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
TIN Issued in IL
Legal business name
HAMILTON LAKES DENTISTRY
Practice address
500 Park Blvd
Suite 180C
Itasca, IL 60143
Phone
(630) 773-6966
Fax
(630) 773-6971
NPI assigned
Jan 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Madge Pierce
Title
Office Manager
Phone
(630) 773-6966

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X TIN IL Primary

Addresses

Primary practice location

500 Park Blvd
Suite 180C
Itasca, IL 60143

Mailing address

500 Park Blvd
Suite 180C
Itasca, IL 60143
Phone (630) 773-6966

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1700938412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 PARK BLVD",
            "address_2": "SUITE 180C",
            "city": "ITASCA",
            "state": "IL",
            "postal_code": "60143",
            "telephone_number": "630-773-6966",
            "fax_number": "630-773-6971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 PARK BLVD",
            "address_2": "SUITE 180C",
            "city": "ITASCA",
            "state": "IL",
            "postal_code": "60143",
            "telephone_number": "630-773-6966",
            "fax_number": "630-773-6971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAMILTON LAKES DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "PIERCE",
        "authorized_official_first_name": "MADGE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "630-773-6966"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "TIN",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Itasca, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.