NPIMap

Organization Active NPI

Elite Care Dental, P.C.

  • Dentist
  • South Holland, IL
National Provider Identifier
1003143017
Registry record updated Nov 11, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019-026564 Issued in IL
Legal business name
ELITE CARE DENTAL, P.C.
Practice address
16111 La Salle St
South Holland, IL 60473-2064
Phone
(708) 339-9999
NPI assigned
Nov 11, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2009

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

Authorized official

Name
Shafaq MustafaNPI 1255321170
Title
Dentist/Owner
Phone
(708) 339-9999

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 019-026564 IL Primary

Addresses

Primary practice location

16111 La Salle St
South Holland, IL 60473-2064

Mailing address

16111 La Salle St
South Holland, IL 60473-2064

National Provider Directory

National Provider Directory

Locations

16111 La Salle St
South Holland, IL 60473
Phone (708) 339-9999

Practitioners & affiliated clinicians

Practitioners 1

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": "1257897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257897600000",
    "number": "1003143017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16111 LA SALLE ST",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604732064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16111 LA SALLE ST",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604732064",
            "telephone_number": "708-339-9999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE CARE DENTAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-11",
        "last_updated": "2009-11-11",
        "status": "A",
        "authorized_official_last_name": "MUSTAFA",
        "authorized_official_first_name": "SHAFAQ",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "708-339-9999"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019-026564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Holland, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 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.