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General NPI Number Information
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NPI Number | 1265508949
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Entity Type | Organization
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Legal Business Name | J.V. DISCIPIO, D.D.S. & ASSOC., LTD.
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6737 STANLEY AVE
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City | BERWYN
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State | IL
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Zip | 60402-3129
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Country | US
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Telephone | 708-749-0133
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Fax | 708-749-7778
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Provider Business Mailing Address
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Address Line | 6737 STANLEY AVE
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City | BERWYN
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State | IL
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Zip | 60402-3129
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Country | US
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Telephone | 708-749-0133
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Fax | 708-749-7778
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Authorized Official
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Title or Position | PRESIDENT-OWNER
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Name | DR. JAMES LAWRENCE DISCIPIO
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Credential | D.D.S., M.S.
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Telephone | 708-749-0133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 19A19017
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 19A-10123
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License Number State | IL
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