Provider Demographics
NPI:1467546689
Name:LAVIERI, JOHN PHILLIP (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PHILLIP
Last Name:LAVIERI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:PHILLIP
Other - Last Name:LAVIERI
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:206 MARQUETTE STREET
Mailing Address - Street 2:SUITE 311
Mailing Address - City:LA SALLE
Mailing Address - State:IL
Mailing Address - Zip Code:61301-2483
Mailing Address - Country:US
Mailing Address - Phone:815-224-1988
Mailing Address - Fax:815-224-3220
Practice Address - Street 1:206 MARQUETTE STREET
Practice Address - Street 2:SUITE 311
Practice Address - City:LA SALLE
Practice Address - State:IL
Practice Address - Zip Code:61301-2483
Practice Address - Country:US
Practice Address - Phone:815-224-1988
Practice Address - Fax:815-224-3220
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T37656Medicare UPIN
IL744340Medicare PIN