Lake Forest Pediatic Dentistry, PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

019024258 Issued in IL

Legal business name

LAKE FOREST PEDIATIC DENTISTRY, PC

Practice address

500 N Western Ave
Suite 215
Lake Forest, IL 60045-1954

Phone

(847) 482-1900

NPI assigned

Jul 25, 2014

Organization subpart

No

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

Authorized official

Name

Joseph Gordon, D.D.S.

Title

Pediatric Dentist, President

Phone

(847) 482-1900

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1406246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406246400000",
    "number": "1841608502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 N WESTERN AVE",
            "address_2": "SUITE 215",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600451954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N WESTERN AVE",
            "address_2": "SUITE 215",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600451954",
            "telephone_number": "847-482-1900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE FOREST PEDIATIC DENTISTRY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-25",
        "last_updated": "2014-07-25",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST, PRESIDENT",
        "authorized_official_telephone_number": "847-482-1900",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": "019024258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lake Forest Ear Nose and Throat LTD
• Lake Forest Hearing Professionals, LLC
• Lake Forest Integrated
• Lake Forest Medical SC
• Lake Forest Obstetrics Gynecology & Infertility S.C.
• Lake Forest Pediatric Associates, LTD
• Lake Forest Place, LLC
• Lake Forest Plastic Surgery LTD.
• Lake Forest Regenesis Medical Center, PLLC
• Lake Forest School District 67

• Dental Clinic/Center in Lake Forest, IL
• Providers in Lake Forest, IL by specialty
• Dental Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2014; 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.