D J Provenzale & D J Provenzale Jr

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

19021170 Issued in IL

Legal business name

D J PROVENZALE & D J PROVENZALE JR

Practice address

4336 Saratoga Ave
Downers Grove, IL 60515

Phone

(630) 969-7711

Fax

(630) 969-7723

NPI assigned

May 3, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Donald J Provenzale Jr., DDSNPI 1538392329

Title

Partner

Phone

(630) 969-7711

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Donald Joseph Provenzale Jr., DDS

  • Dentist
  • Downers Grove, IL
  • NPI 1538392329
  NPD (past) Authorized official

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710109145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4336 SARATOGA AVE",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "60515",
            "telephone_number": "630-969-7711",
            "fax_number": "630-969-7723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4336 SARATOGA AVE",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "60515",
            "telephone_number": "630-969-7711",
            "fax_number": "630-969-7723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "D J PROVENZALE & D J PROVENZALE JR",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PROVENZALE",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "630-969-7711",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "19021170",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "19A12314",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Currie, DPT
• Debra D Cushing, RDH
• Brian R. Czapko, APN
• Sarah Czopek
• D G Counseling Inc
• Fortunata Gelvolea Dabu, NP
• Mary Sue Dailey, APRN
• Arvydas J Dailide, DDS
• Neil K Dalal, DO
• Dale W. Faber, LCSW, P.C.

• General Practice Dentistry in Downers Grove, IL
• Providers in Downers Grove, 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 Aug 22, 2020; 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.