NPIMap

Organization Active NPI

College Square Dental

  • General Practice Dentistry
  • Lisle, IL
National Provider Identifier
1760665442
Registry record updated Apr 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019-019814 Issued in IL
Legal business name
COLLEGE SQUARE DENTAL
Practice address
6448 College Rd
Lisle, IL 60532-3290
Phone
(630) 983-8700
NPI assigned
Dec 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2018

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

Authorized official

Name
Deann Derrico
Title
Business Administrator
Phone
(630) 983-8700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 019-019814 IL Primary

Addresses

Primary practice location

6448 College Rd
Lisle, IL 60532-3290

Mailing address

6448 College Rd
Lisle, IL 60532-3290
Phone (630) 983-8700

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1197849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523318400000",
    "number": "1760665442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6448 COLLEGE RD",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605323290",
            "telephone_number": "630-983-8700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6448 COLLEGE RD",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605323290",
            "telephone_number": "630-983-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLEGE SQUARE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-17",
        "last_updated": "2018-04-10",
        "status": "A",
        "authorized_official_last_name": "DERRICO",
        "authorized_official_first_name": "DEANN",
        "authorized_official_title_or_position": "BUSINESS ADMINISTRATOR",
        "authorized_official_telephone_number": "630-983-8700"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019-019814",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lisle, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2018; 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.