NPIMap

Organization Active NPI

Star Smiles Orthodontics and Pediatric Dentistry

  • Dental Clinic/Center
  • Chicago, IL
National Provider Identifier
1013347160
Registry record updated Nov 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
019028920 Issued in IL
Legal business name
STAR SMILES ORTHODONTICS AND PEDIATRIC DENTISTRY
Practice address
3012 W Fullerton Ave
Chicago, IL 60647-2940
Phone
(773) 384-3500
Fax
(773) 384-3963
NPI assigned
Nov 26, 2013
Last updated
Nov 26, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2013

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

Authorized official

Name
Dr. Andre Jham, DDS
Title
Orthodontics
Phone
(773) 384-3500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 019028920 IL Primary

Addresses

Primary practice location

3012 W Fullerton Ave
Chicago, IL 60647-2940

Mailing address

3012 W Fullerton Ave
Chicago, IL 60647-2940
Phone (773) 384-3500

Other identifiers 1

IdentifierTypeStateIssuer
019028920MedicaidIL

National Provider Directory

National Provider Directory
Tax ID family
Star Smiles Orthodontics and Pediatric Dentistry2 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.

Locations

3012 W Fullerton Ave
Chicago, IL 60647
Phone (773) 384-3500

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1385424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385424000000",
    "number": "1013347160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3012 W FULLERTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606472940",
            "telephone_number": "773-384-3500",
            "fax_number": "773-384-3963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3012 W FULLERTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606472940",
            "telephone_number": "773-384-3500",
            "fax_number": "773-384-3963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAR SMILES ORTHODONTICS AND PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-26",
        "last_updated": "2013-11-26",
        "status": "A",
        "authorized_official_last_name": "JHAM",
        "authorized_official_first_name": "ANDRE",
        "authorized_official_title_or_position": "ORTHODONTICS",
        "authorized_official_telephone_number": "773-384-3500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": "019028920",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019028920",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2013; 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.