NPIMap

Organization Active NPI

Ogden Valley Dental

  • General Practice Dentistry
  • Naperville, IL
National Provider Identifier
1013248368
Registry record updated Dec 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
OGDEN VALLEY DENTAL
Practice address
1224 W Ogden Ave
Naperville, IL 60563-2952
Phone
(630) 305-6161
Fax
(630) 701-1966
NPI assigned
Jan 27, 2010
Organization subpart
Yes
Parent organization
TWO RIVERS DENTAL PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 10, 2020

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

Authorized official

Name
Sohail S Shafi
Title
Manager
Phone
(630) 842-3705

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1224 W Ogden Ave
Naperville, IL 60563-2952

Mailing address

1730 Park St Ste 106
Naperville, IL 60563-2609
Phone (630) 305-6161

National Provider Directory

National Provider Directory
Tax ID family
Simply Dental8 organizations share this tax ID, including this one
Part of
Simply Dental

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1224 W Ogden Ave
Naperville, IL 60563
Phone (630) 305-6161

Practitioners & affiliated clinicians

Practitioners 4

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": "1264550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607558400000",
    "number": "1013248368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1730 PARK ST STE 106",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605632609",
            "telephone_number": "630-305-6161",
            "fax_number": "630-701-1966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1224 W OGDEN AVE",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605632952",
            "telephone_number": "630-305-6161",
            "fax_number": "630-701-1966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OGDEN VALLEY DENTAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TWO RIVERS DENTAL PC",
        "enumeration_date": "2010-01-27",
        "last_updated": "2020-12-10",
        "certification_date": "2020-12-10",
        "status": "A",
        "authorized_official_last_name": "SHAFI",
        "authorized_official_first_name": "SOHAIL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "630-842-3705"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Naperville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2020; 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.