NPIMap

Organization Active NPI

Portage Park Dental Associates, LTD

  • Dentist
  • Chicago, IL
National Provider Identifier
1003124371
Registry record updated Sep 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019026570 Issued in IL
Legal business name
PORTAGE PARK DENTAL ASSOCIATES, LTD
Practice address
5613 W Irving Park Rd
Chicago, IL 60634-2740
Phone
(773) 286-4030
Fax
(773) 736-0716
NPI assigned
Sep 20, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Aneta Choma-Dlouchy, DDSNPI 1699084400
Title
President
Phone
(773) 286-4030

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 019026570 IL Primary

Addresses

Primary practice location

5613 W Irving Park Rd
Chicago, IL 60634-2740

Mailing address

5613 W Irving Park Rd
Chicago, IL 60634-2740
Phone (773) 286-4030

National Provider Directory

National Provider Directory

Locations

5613 W Irving Park Rd
Chicago, IL 60634
Phone (773) 286-4030

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1284940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284940800000",
    "number": "1003124371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5613 W IRVING PARK RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606342740",
            "telephone_number": "773-286-4030",
            "fax_number": "773-736-0716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5613 W IRVING PARK RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606342740",
            "telephone_number": "773-286-4030",
            "fax_number": "773-736-0716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTAGE PARK DENTAL ASSOCIATES, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-20",
        "last_updated": "2010-09-20",
        "status": "A",
        "authorized_official_last_name": "CHOMA-DLOUCHY",
        "authorized_official_first_name": "ANETA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-286-4030",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019026570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.