NPIMap

Organization Active NPI

Lemont Dental Clinic

  • Dentist
  • Lemont, IL
National Provider Identifier
1972964005
Registry record updated Mar 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019.028040 Issued in IL
Legal business name
LEMONT DENTAL CLINIC
Practice address
14240 McCarthy Rd.
Lemont, IL 60439-9393
Phone
(630) 914-1500
Fax
(630) 914-1501
NPI assigned
Mar 17, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2016

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

Authorized official

Name
Dr. Beata Dederowski, D.M.DNPI 1265662423
Title
President
Phone
(708) 914-1500

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
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 019.028040 IL Primary

Addresses

Primary practice location

14240 McCarthy Rd.
Lemont, IL 60439-9393

Mailing address

14240 McCarthy Rd
Lemont, IL 60439-9393
Phone (630) 914-1500

National Provider Directory

National Provider Directory

Locations

14240 McCarthy Rd
Lemont, IL 60439
Phone (630) 914-1500

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1458172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458172800000",
    "number": "1972964005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14240 MCCARTHY RD",
            "city": "LEMONT",
            "state": "IL",
            "postal_code": "604399393",
            "telephone_number": "630-914-1500",
            "fax_number": "630-914-1501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14240 MCCARTHY RD.",
            "city": "LEMONT",
            "state": "IL",
            "postal_code": "604399393",
            "telephone_number": "630-914-1500",
            "fax_number": "630-914-1501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEMONT DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-17",
        "last_updated": "2016-03-17",
        "status": "A",
        "authorized_official_last_name": "DEDEROWSKI",
        "authorized_official_first_name": "BEATA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-914-1500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.028040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lemont, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2016; 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.