Libertyville Oral Surgery PC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

LIBERTYVILLE ORAL SURGERY PC

Practice address

1236 American Way
Libertyville, IL 60048-3936

Phone

(847) 367-8656

NPI assigned

Aug 3, 2023

Organization subpart

Yes

Parent organization

LIBERTYVILLE ORAL SURGERY PCAs reported in NPPES

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

Authorized official

Name

Dr. Bryan Vanoven, DDSNPI 1720290174

Title

Oral Maxillofacial Surgeon

Phone

(847) 367-8656

Specialties & licenses 1

Addresses

Other names 1

• Libertyville Oral Surgery and Dental Implants Doing business as

Part of

Libertyville Oral Surgery PC

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bryan Joel Vanoven, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Libertyville, IL
  • NPI 1720290174
  NPD Authorized official

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

{
    "created_epoch": "1691020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691020800000",
    "number": "1891477352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1236 AMERICAN WAY",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600483936",
            "telephone_number": "847-367-8656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1236 AMERICAN WAY",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600483936",
            "telephone_number": "847-367-8656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTYVILLE ORAL SURGERY PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIBERTYVILLE ORAL SURGERY PC",
        "enumeration_date": "2023-08-03",
        "last_updated": "2023-08-03",
        "certification_date": "2023-08-03",
        "status": "A",
        "authorized_official_last_name": "VANOVEN",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "ORAL MAXILLOFACIAL SURGEON",
        "authorized_official_telephone_number": "847-367-8656",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Libertyville Oral Surgery and Dental Implants",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Libertyville Longevity and Light Center
• Libertyville Manor
• Libertyville Manor Extended Care Facility, Inc.
• Libertyville Neurosurgery, LLC
• Libertyville OBGYN S.C.
• Libertyville Pediatric Dentistry
• Libertyville Podiatry
• Libertyville Podiatry PC
• Libertyville School District #70
• Libertyville Skilled Nursing Facility LLC

• Oral and Maxillofacial Surgery (Dentist) in Libertyville, IL
• Providers in Libertyville, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2023; 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.