Provider Demographics
NPI:1265508949
Name:J.V. DISCIPIO, D.D.S. & ASSOC., LTD.
Entity type:Organization
Organization Name:J.V. DISCIPIO, D.D.S. & ASSOC., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:DISCIPIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:708-749-0133
Mailing Address - Street 1:6737 STANLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3129
Mailing Address - Country:US
Mailing Address - Phone:708-749-0133
Mailing Address - Fax:708-749-7778
Practice Address - Street 1:6737 STANLEY AVE
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:708-749-7778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A190171223G0001X
IL19A-101231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$OtherSOCIAL SECURITY NUMBER
IL$$$$$$$$$OtherSOCIAL SECURITY NUMBER