Active NPI
Russell P Pesavento, DDS
- Dentist
- Joliet, IL
National Provider Identifier
1861933137
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019.030884
- Practice address
- 1118 N Larkin Ave
Joliet, IL 60435-3456 - Phone
- (815) 714-2271
- NPI assigned
- Mar 20, 2017
- Sex
- Male
- Sole proprietor
- Yes
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 | 019.030884 | IL | Primary |
Addresses
Primary practice location
1118 N Larkin Ave
Joliet, IL 60435-3456
Mailing address
1118 N Larkin Ave
Joliet, IL 60435-3456
Phone (815) 714-2271
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 |
|---|---|---|---|
| 019.030884 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1489968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489968000000",
"number": "1861933137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1118 N LARKIN AVE",
"city": "JOLIET",
"state": "IL",
"postal_code": "604353456",
"telephone_number": "815-714-2271"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1118 N LARKIN AVE",
"city": "JOLIET",
"state": "IL",
"postal_code": "604353456",
"telephone_number": "815-714-2271"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PESAVENTO",
"first_name": "RUSSELL",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-03-20",
"last_updated": "2017-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019.030884",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Joliet, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.