NPIMap

Organization Active NPI

Advanced Lisle Dental

  • Preferred Provider Organization
  • Lisle, IL
National Provider Identifier
1972936334
Registry record updated Aug 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
019027403 Issued in IL
Legal business name
ADVANCED LISLE DENTAL
Practice address
1046 Maple Ave
Lisle, IL 60532-2329
Phone
(630) 890-6102
NPI assigned
Aug 20, 2013
Last updated
Aug 20, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2013

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

Authorized official

Name
Hetalkumar PatelNPI 1750586061
Title
Owner
Phone
(630) 890-6102

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X 019027403 IL Primary

Addresses

Primary practice location

1046 Maple Ave
Lisle, IL 60532-2329

Mailing address

1046 Maple Ave
Lisle, IL 60532-2329

National Provider Directory

National Provider Directory

Locations

1046 Maple Ave
Lisle, IL 60532
Phone (630) 890-6102

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1376956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376956800000",
    "number": "1972936334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1046 MAPLE AVE",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605322329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1046 MAPLE AVE",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605322329",
            "telephone_number": "630-890-6102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED LISLE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-20",
        "last_updated": "2013-08-20",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "HETALKUMAR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-890-6102"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "IL",
            "license": "019027403",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lisle, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2013; 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.