Provider Demographics
NPI:1639239866
Name:DISCIPIO, JAMES LAWRENCE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LAWRENCE
Last Name:DISCIPIO
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 NEWBERRY
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60526-1656
Mailing Address - Country:US
Mailing Address - Phone:708-352-0826
Mailing Address - Fax:708-749-7778
Practice Address - Street 1:6737 W. STANLEY AVENUE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3129
Practice Address - Country:US
Practice Address - Phone:708-749-0133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A190171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice