College Avenue Dental Sleep Appliances LTD.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

019019857 Issued in IL

Legal business name

COLLEGE AVENUE DENTAL SLEEP APPLIANCES LTD.

Practice address

505 W College Ave
Jacksonville, IL 62650-2405

Phone

(217) 245-5313

Fax

(217) 383-0204

NPI assigned

Mar 24, 2014

Last updated

Apr 22, 2014By 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

Randall Evert Lawson, DDSNPI 1730151176

Title

Owner

Phone

(217) 473-6758

Specialties & licenses 1

Addresses

Other names 1

• Randall E Lawson DDS Other name

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

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.

• Randall Evert Lawson, D.D.S.

  • General Practice Dentistry
  • Jacksonville, IL
  • NPI 1730151176
  NPD Authorized official

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

{
    "created_epoch": "1395619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398124800000",
    "number": "1962829366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 W COLLEGE AVE",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626502405",
            "telephone_number": "217-245-5313",
            "fax_number": "217-383-0204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 W COLLEGE AVE",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626502405",
            "telephone_number": "217-245-5313",
            "fax_number": "217-383-0204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLEGE AVENUE DENTAL SLEEP APPLIANCES LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-24",
        "last_updated": "2014-04-22",
        "status": "A",
        "authorized_official_last_name": "LAWSON",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "EVERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "217-473-6758",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IL",
            "license": "019019857",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Randall E Lawson DDS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Beaux Cole, PHARM. D.
• Carrie S Cole, RN
• Jonathan Daniel Colen, DO
• Michelle Colen, M.D.
• Collaborative Medical PLLC
• Community Living Options Inc (Campbell Court)
• Community Living Options Inc (Anna Terrace)
• Community Living Options Inc (Eisenhower Terrace)
• Community Living Options Inc (Lafayette Terrace)
• Community Living Options Inc (Douglas Terrace)

• Durable Medical Equipment & Medical Supplies in Jacksonville, IL
• Providers in Jacksonville, IL by specialty
• Durable Medical Equipment & Medical Supplies in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.