NPIMap

Organization Active NPI

Modern Art of Dentistry, Inc

  • Dental Clinic/Center
  • Wheeling, IL
National Provider Identifier
1003142100
Registry record updated Oct 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
0019-024691 Issued in IL
Legal business name
MODERN ART OF DENTISTRY, INC
Practice address
75 S Milwaukee Ave
Wheeling, IL 60090-3187
Phone
(847) 465-0800
Fax
(847) 465-0053
NPI assigned
Oct 23, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2009

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

Authorized official

Name
Dr. Karina Lyon Gavrilov, DDSNPI 1376641639
Title
Owner
Phone
(847) 465-0800

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
Dental Clinic/Center 261QD0000X 0019-024691 IL Primary

Addresses

Primary practice location

75 S Milwaukee Ave
Wheeling, IL 60090-3187

Mailing address

75 S Milwaukee Ave
Wheeling, IL 60090-3187
Phone (847) 465-0800

National Provider Directory

National Provider Directory

Locations

75 S Milwaukee Ave
Wheeling, IL 60090
Phone (847) 465-0800

Practitioners & affiliated clinicians

Practitioners 2

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": "1256256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256256000000",
    "number": "1003142100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 S MILWAUKEE AVE",
            "city": "WHEELING",
            "state": "IL",
            "postal_code": "600903187",
            "telephone_number": "847-465-0800",
            "fax_number": "847-465-0053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 S MILWAUKEE AVE",
            "city": "WHEELING",
            "state": "IL",
            "postal_code": "600903187",
            "telephone_number": "847-465-0800",
            "fax_number": "847-465-0053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN ART OF DENTISTRY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-23",
        "last_updated": "2009-10-23",
        "status": "A",
        "authorized_official_last_name": "LYON GAVRILOV",
        "authorized_official_first_name": "KARINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-465-0800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": "0019-024691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheeling, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2009; 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.