INNOVATIVE PEDIATRIC DENTISTRY (NPI# 1447644802) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447644802 |
| Entity Type | Organization |
| Organization Name | INNOVATIVE PEDIATRIC DENTISTRY |
| Practice Address |
55 S Main St Ste 241 Naperville IL 60540-5377 |
| Practice Telephone | 6308482010 |
| Practice Fax Number | 6308482011 |
| Mailing Telephone | 6308482010 |
| Mailing Fax Number | 6308482011 |
| Enumeration Date | 2015-03-24 |
| Last Update Date | 2015-03-24 |
| Authorized Official Name | DR. ANTHONY LAVACCA (PRESIDENT) |
| Authorized Official Telephone | 6308482010 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
4744296 | IL | Dental Providers |
| Street Address |
55 S MAIN ST STE 241 |
| City | NAPERVILLE |
| State | IL |
| Zip Code | 60540-5377 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528550688 | Dustin Durnell | Dentist | 55 S Main St Ste 241, Naperville, IL 60540-5377 | 2018-06-05 |
| 1538612957 | Dona Toumeh | Dentist | 55 S Main St Ste 241, Naperville, IL 60540-5377 | 2016-08-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760007678 | Mandalai Oral and Maxillofacial Surgery PC | Oral & Maxillofacial Surgery | 720 S. Brom Drive Suite 103, Naperville, IL 60540 | 2020-06-16 |
| 1316418957 | James Edward Frank | Counselor | 600 South Washington Street, Suite 302, Naperville, IL 60540 | 2018-12-07 |
| 1093208332 | Ingrid Johnson | Developmental Therapist | Right Start Pediatric Therapies, 50 S Main St Suite 200, Naperville, IL 60540 | 2018-06-12 |
| 1225528524 | Tara Rada Nieberding | Contractor | 1701 Quincy Ave Ste 12, Naperville, IL 60540 | 2018-05-14 |
| 1588182190 | Debra Xiangjun Hayes | Acupuncturist | 226 N Washington St # 2, Naperville, IL 60540 | 2017-09-03 |
| 1487197166 | Health Improvement and Preventive Services LLC | Family Medicine | 1979 Mcdowell Rd., Suite 103, Naperville, IL 60540 | 2016-11-29 |
| 1588013775 | Matthew Jacob Imber | Chiropractor | 1220 Hobson Rd Ste 220, Naperville, IL 60540 | 2016-06-08 |
| 1457711418 | Elite Pain Medical Group Inc | Physical Medicine & Rehabilitation | 720 South Brom Drive, Suite 201, Naperville, IL 60540 | 2016-03-03 |
| 1265814800 | Jenifer Lynn Mersman | Chiropractor | 475 River Bend Rd. Suite 104, Naperville, IL 60540 | 2015-06-19 |
| 1386038016 | Jonathon Martin Ruiz | Specialist/Technologist | 440 N Brainard Street, Naperville, IL 60540 | 2015-03-19 |
| Find all providers in zip 60540 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679644819 | Kurt Arthur Wagner | Dentist | 47 E Chicago Ave, Suite 344, Naperville, IL 60540-5325 | 2006-11-10 |
| 1649593427 | Eryn Grace Amelia Donohue | Dentist | 1220 Hobson Rd, Ste. #224, Naperville, IL 60540-8139 | 2010-03-08 |
| 1013121748 | David Lynn Jones | Dentist | 1816 Bay Scott Cir, Ste 104, Naperville, IL 60540-1112 | 2007-05-10 |
| 1629109293 | Michael G Peske | Dentist | 720 Brom Ct, Suite 201, Naperville, IL 60540-6531 | 2007-03-08 |
| 1083797856 | Thomas M Donohue | Dentist | 1220 Hobson Rd, Ste 224, Naperville, IL 60540-8139 | 2006-10-23 |
| 1609957596 | Just for Kids Pediatric Dentistry, Ltd. | Dentist | 1220 Hobson Rd, Ste 224, Naperville, IL 60540-8139 | 2006-10-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932709433 | Children's Center for Dentistry | Dentist | 314 Susan Dr, Normal, IL 61761-6206 | 2020-10-26 |
| 1073125746 | Jessica Mattern Dds, Pllc | Dentist | 326 W Burlington Ave, La Grange, IL 60525-2363 | 2020-08-23 |
| 1568925014 | Southern Illinois Pediatric Dentistry of Edwardsville | Dentist | 1419 Lewis Road, Suite 2, Edwardsville, IL 62025 | 2019-04-11 |
| 1710450754 | Drs Selberg & Rice Pllc | Dentist | 4945 Stone Falls Ctr Ste B, O Fallon, IL 62269-7801 | 2019-01-02 |
| 1821583634 | Dentalgenix | Dentist | 113 E Schaumburg Rd, Schaumburg, IL 60194-3518 | 2018-06-25 |
| 1528562253 | Rachel Vorwaller | Dentist | 1460 N Halsted St Ste 403, Chicago, IL 60642-2607 | 2018-03-19 |
| 1942740006 | Dhwani M. Joshi | Dentist | 195 S Rand Rd Ste 110, Lake Zurich, IL 60047-2205 | 2017-03-08 |
| 1316393390 | Erin Marie Petrik | Dentist | 2530 N Clark St, Apt 203, Chicago, IL 60614-4972 | 2016-05-10 |
| 1669839593 | Algonquin Kids Dentistry, Inc | Dentist | 4097 W Algonquin Rd, Algonquin, IL 60102-9401 | 2016-01-22 |
| 1720468598 | Mehedia Haque | Dentist | 2062 N Milwaukee Ave, Chicago, IL 60647 | 2015-06-05 |
| Find all providers with the same taxonomy | ||||
| City | NAPERVILLE |
| Zip Code | 60540 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.