Decatur 2014

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DECATUR 2014

Practice address

141 E Pershing Rd
Suite 610
Decatur, IL 62526-3213

Phone

(888) 988-4066

Fax

(847) 496-7603

NPI assigned

Jun 20, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Koushan Azad, DMD

Title

Oenwr /President

Phone

(888) 988-4066

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1340150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340150400000",
    "number": "1003179482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 E ALGONQUIN RD",
            "address_2": "SUITE 610",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601734144",
            "telephone_number": "888-988-4066",
            "fax_number": "847-496-7603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 E PERSHING RD",
            "address_2": "SUITE 610",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625263213",
            "telephone_number": "888-988-4066",
            "fax_number": "847-496-7603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DECATUR 2014",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-20",
        "last_updated": "2012-06-20",
        "status": "A",
        "authorized_official_last_name": "AZAD",
        "authorized_official_first_name": "KOUSHAN",
        "authorized_official_title_or_position": "OENWR /PRESIDENT",
        "authorized_official_telephone_number": "888-988-4066",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mohammed Dawood, M.D.
• Carlton Dean, PHARM.D.
• Zaria Deberry
• Decatur 2012 LLC
• Decatur 2013 LLC
• Decatur 2015 LLC
• Decatur 2016 LLC
• Decatur Ambulance Service, Inc.
• Decatur Athletic Club
• Decatur City Taxi & Delivery Inc

• General Practice Dentistry in Decatur, IL
• Providers in Decatur, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2012; 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.