NPIMap

Organization Active NPI

Familia Dental Esl 4LLC

  • General Practice Dentistry
  • East Saint Louis, IL
National Provider Identifier
1013283126
Registry record updated Mar 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019026920 Issued in IL
Legal business name
FAMILIA DENTAL ESL 4LLC
Practice address
2608 State St
East Saint Louis, IL 62205-2325
Phone
(888) 988-4066
Fax
(847) 496-7202
NPI assigned
Mar 23, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2012

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

Authorized official

Name
Koushan Azad, DMD
Title
President
Phone
(888) 988-4066

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 019026920 IL Primary

Addresses

Primary practice location

2608 State St
East Saint Louis, IL 62205-2325

Mailing address

2050 E Algonquin Rd
610
Schaumburg, IL 60173-4144
Phone (888) 988-4066

National Provider Directory

National Provider Directory
Tax ID family
Familia Dental Esl 4 LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1332460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332460800000",
    "number": "1013283126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 E ALGONQUIN RD",
            "address_2": "610",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601734144",
            "telephone_number": "888-988-4066",
            "fax_number": "847-496-7202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2608 STATE ST",
            "city": "EAST SAINT LOUIS",
            "state": "IL",
            "postal_code": "622052325",
            "telephone_number": "888-988-4066",
            "fax_number": "847-496-7202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILIA DENTAL ESL 4LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-23",
        "last_updated": "2012-03-23",
        "status": "A",
        "authorized_official_last_name": "AZAD",
        "authorized_official_first_name": "KOUSHAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "888-988-4066",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019026920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Saint Louis, IL

Sources for this page

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