NPIMap

Organization Active NPI

Two Rivers Dental

  • General Practice Dentistry
  • Bolingbrook, IL
National Provider Identifier
1760712855
Registry record updated Dec 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019024809 Issued in IL
Legal business name
TWO RIVERS DENTAL
Practice address
1196 W Boughton Rd
Bolingbrook, IL 60440-6567
Phone
(630) 759-9929
Fax
(630) 759-9922
NPI assigned
Jan 12, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2020

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

Authorized official

Name
Sohail S Shafi
Title
Manager
Phone
(630) 842-3705

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 019024809 IL Primary

Addresses

Primary practice location

1196 W Boughton Rd
Bolingbrook, IL 60440-6567

Mailing address

1730 Park St Ste 106
Naperville, IL 60563-2609
Phone (630) 759-9929

National Provider Directory

National Provider Directory
Tax ID family
Simply Dental8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1196 W Boughton Rd
Bolingbrook, IL 60440
Phone (630) 759-9929

NPI Registry JSON

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

{
    "created_epoch": "1263254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607558400000",
    "number": "1760712855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1730 PARK ST STE 106",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605632609",
            "telephone_number": "630-759-9929",
            "fax_number": "630-759-9922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1196 W BOUGHTON RD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604406567",
            "telephone_number": "630-759-9929",
            "fax_number": "630-759-9922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TWO RIVERS DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-12",
        "last_updated": "2020-12-10",
        "certification_date": "2020-12-10",
        "status": "A",
        "authorized_official_last_name": "SHAFI",
        "authorized_official_first_name": "SOHAIL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "630-842-3705"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019024809",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bolingbrook, IL

Sources for this page

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