Active NPI
John Paul Haxton, D.D.S
- Dentist
- Great Lakes, IL
National Provider Identifier
1730125394
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6618
- Practice address
- Fisher Clinic, 2410 Sampson St.
BLDG 237
Great Lakes, IL 60088-5230 - Phone
- (847) 688-3331
- NPI assigned
- Jun 21, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 6618 | NE | Primary |
Addresses
Primary practice location
Fisher Clinic, 2410 Sampson St.
BLDG 237
Great Lakes, IL 60088-5230
Mailing address
1145 North Museum Blvd.
Apt. 702
Vernon Hills, IL 60061
Phone (847) 732-6723
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6618 | NE | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1730125394",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1145 NORTH MUSEUM BLVD.",
"address_2": "APT. 702",
"city": "VERNON HILLS",
"state": "IL",
"postal_code": "60061",
"telephone_number": "847-732-6723"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "FISHER CLINIC, 2410 SAMPSON ST.",
"address_2": "BLDG 237",
"city": "GREAT LAKES",
"state": "IL",
"postal_code": "600885230",
"telephone_number": "847-688-3331"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAXTON",
"first_name": "JOHN",
"middle_name": "PAUL",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NE",
"license": "6618",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Great Lakes, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.