Active NPI
Cassidy Veronica Phagan, DDS
- Dentist
- Grayslake, IL
National Provider Identifier
1790338853
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 00
- Practice address
- 719 Barron Blvd
Grayslake, IL 60030-3314 - Phone
- (847) 986-6724
- NPI assigned
- Jul 18, 2019
- Last updated
- Jul 18, 2019
- Sex
- Female
- 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 | 00 | IL | Primary |
Addresses
Primary practice location
719 Barron Blvd
Grayslake, IL 60030-3314
Mailing address
2527 N Springfield Ave Unit 1
Chicago, IL 60647-1028
Phone (847) 721-7628
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 |
|---|---|---|---|
| 00 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1563408000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563408000000",
"number": "1790338853",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2527 N SPRINGFIELD AVE UNIT 1",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606471028",
"telephone_number": "847-721-7628"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "719 BARRON BLVD",
"city": "GRAYSLAKE",
"state": "IL",
"postal_code": "600303314",
"telephone_number": "847-986-6724"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAGAN",
"first_name": "CASSIDY",
"middle_name": "VERONICA",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-07-18",
"last_updated": "2019-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "00",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grayslake, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.