NPIMap

Organization Active NPI

Lincolnway Dental Center, PC

  • General Practice Dentistry
  • North Aurora, IL
National Provider Identifier
1801963558
Registry record updated Apr 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019020375 Issued in IL
Legal business name
LINCOLNWAY DENTAL CENTER, PC
Practice address
417 S Lincolnway
Suite a
North Aurora, IL 60542-5109
Phone
(630) 897-1300
Fax
(630) 897-7172
NPI assigned
Nov 29, 2006
Last updated
Apr 23, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2008

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

Authorized official

Name
Dr. Dean Moon Park, D.M.D.NPI 1679748586
Title
President
Phone
(630) 897-1300

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 019022694 IL
General Practice Dentistry 1223G0001X 019024704 IL
General Practice Dentistry 1223G0001X 019020375 IL Primary

Addresses

Primary practice location

417 S Lincolnway
Suite a
North Aurora, IL 60542-5109

Mailing address

417 S Lincolnway
Suite a
North Aurora, IL 60542-5109
Phone (630) 897-1300

National Provider Directory

National Provider Directory

Locations

417 S Lincolnway
Ste A
North Aurora, IL 60542
Phone (630) 897-1300

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208908800000",
    "number": "1801963558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 S LINCOLNWAY",
            "address_2": "SUITE A",
            "city": "NORTH AURORA",
            "state": "IL",
            "postal_code": "605425109",
            "telephone_number": "630-897-1300",
            "fax_number": "630-897-7172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 S LINCOLNWAY",
            "address_2": "SUITE A",
            "city": "NORTH AURORA",
            "state": "IL",
            "postal_code": "605425109",
            "telephone_number": "630-897-1300",
            "fax_number": "630-897-7172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINCOLNWAY DENTAL CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2008-04-23",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "DEAN",
        "authorized_official_middle_name": "MOON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-897-1300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019022694",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019024704",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019020375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Aurora, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 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.