Lavender Rose Dental

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

LAVENDER ROSE DENTAL

Practice address

333 N Morehead St
Chenoa, IL 61726-1001

Phone

(815) 945-7808

NPI assigned

Sep 22, 2020

Last updated

Sep 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shima Phoenix, DMDNPI 1588040976

Title

Dentist

Phone

(575) 840-4838

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

Practitioners 2

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.

• Shima Phoenix, DMD

  • Dentist
  • Mount Vernon, IL
  • NPI 1588040976
  NPD Authorized official
• Robert A. Tripke, D.M.D.

  • Dentist
  • Chenoa, IL
  • NPI 1083873418
  NPD (past)

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

{
    "created_epoch": "1600732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600732800000",
    "number": "1902412158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 N MOREHEAD ST",
            "city": "CHENOA",
            "state": "IL",
            "postal_code": "617261001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 N MOREHEAD ST",
            "city": "CHENOA",
            "state": "IL",
            "postal_code": "617261001",
            "telephone_number": "815-945-7808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAVENDER ROSE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-22",
        "last_updated": "2020-09-22",
        "certification_date": "2020-09-22",
        "status": "A",
        "authorized_official_last_name": "PHOENIX",
        "authorized_official_first_name": "SHIMA",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "575-840-4838",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.lavenderrosedental.com",
            "affiliation": "N",
            "address_1": "333 N Morehead St",
            "city": "Chenoa",
            "state": "IL",
            "country_code": "US",
            "postal_code": "617261001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Chenoa Ambulance Service Association (Casa)
• Amanda K Krutke, FNP-BC
• Tanya L Landrus
• Letitride Inc (Chenoa Rx LTC)
• Letitride Inc (Chenoa rx)
• Lynn Ann Martie, MS CCC-SLP
• Meadows Mennonite Retirement Community (Show Bus Meadows)
• Meadows Mennonite Retirement Community Association, Inc. (Meadows Mennonite Home)

• Dental Clinic/Center in Chenoa, IL
• Providers in Chenoa, 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 Sep 22, 2020; 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.