NPIMap

Organization Active NPI

Roscoe Family Dental Center, P.C.

  • General Practice Dentistry
  • Roscoe, IL
National Provider Identifier
1780839837
Registry record updated Nov 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
060009728 Issued in IL
Legal business name
ROSCOE FAMILY DENTAL CENTER, P.C.
Practice address
5640 Clayton Cir
Roscoe, IL 61073-9503
Phone
(815) 623-7366
Fax
(815) 623-7331
NPI assigned
Nov 17, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2008

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

Authorized official

Name
Dr. Vaughn De GuzmanNPI 1104008515
Title
Dentist
Phone
(815) 623-7366

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 060009728 IL Primary

Addresses

Primary practice location

5640 Clayton Cir
Roscoe, IL 61073-9503

Mailing address

5640 Clayton Cir
P.O. Box 967
Roscoe, IL 61073-9503
Phone (815) 623-7366

National Provider Directory

National Provider Directory

Locations

5640 Clayton Cir
Roscoe, IL 61073
Phone (815) 623-7366

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": "1226880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226880000000",
    "number": "1780839837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5640 CLAYTON CIR",
            "address_2": "P.O. BOX 967",
            "city": "ROSCOE",
            "state": "IL",
            "postal_code": "610739503",
            "telephone_number": "815-623-7366",
            "fax_number": "815-623-7331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5640 CLAYTON CIR",
            "city": "ROSCOE",
            "state": "IL",
            "postal_code": "610739503",
            "telephone_number": "815-623-7366",
            "fax_number": "815-623-7331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSCOE FAMILY DENTAL CENTER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-17",
        "last_updated": "2008-11-17",
        "status": "A",
        "authorized_official_last_name": "DE GUZMAN",
        "authorized_official_first_name": "VAUGHN",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "815-623-7366",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "060009728",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roscoe, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2008; 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.