Bryan Joel Vanoven, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

021002313 Issued in IL

Practice address

1236 American Way
Libertyville, IL 60048-3936

Phone

(847) 367-8656

Fax

(847) 557-1361

NPI assigned

May 5, 2007

Last updated

Nov 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective May 24, 2022 through May 24, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Libertyville Oral Surgery PC

  dba Libertyville Oral Surgery and Dental Implants

  • Oral and Maxillofacial Surgery (Dentist)
  • Libertyville, IL
  • NPI 1891477352
  NPD Authorized official
• Associates for Oral Maxillofacial and Implant Surgery LTD

  • Oral and Maxillofacial Surgery (Dentist)
  • Mount Prospect, IL
  • NPI 1114911872
  NPD (past)

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

{
    "created_epoch": "1178323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699315200000",
    "number": "1720290174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1236 AMERICAN WAY",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600483936",
            "telephone_number": "847-367-8656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1236 AMERICAN WAY",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600483936",
            "telephone_number": "847-367-8656",
            "fax_number": "847-557-1361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANOVEN",
        "first_name": "BRYAN",
        "middle_name": "JOEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-05",
        "last_updated": "2023-11-07",
        "certification_date": "2023-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OK",
            "license": "5681",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "021002313",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Martin John Valente, MD
• Hannah Marie Valladares
• Lynette D Vanbeek, PT
• Alexandria Vanerden
• Megan Vanhoorebeke
• Gregory Vayl, CRNA
• Tracy Vazquez
• Angela Vega, APRN
• Sara R Vegh, M.D.
• Sally Ventura

• Oral and Maxillofacial Surgery (Dentist) in Libertyville, IL
• Providers in Libertyville, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.