Pediatric Dental Surgical Associates PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

PEDIATRIC DENTAL SURGICAL ASSOCIATES PLLC

Practice address

2550 W Addison St
Chicago, IL 60618-5952

Phone

(773) 423-6050

NPI assigned

Jan 4, 2019

Organization subpart

No

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

Authorized official

Name

Johnny Kuttab

Title

Ceo

Phone

(773) 423-6050

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lauren Ming

  • Dentist
  • Chicago, IL
  • NPI 1356876635
  NPD (past)

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

{
    "created_epoch": "1546560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546560000000",
    "number": "1013480755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 W ADDISON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606185952",
            "telephone_number": "773-423-6050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 W ADDISON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606185952",
            "telephone_number": "773-423-6050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTAL SURGICAL ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-04",
        "last_updated": "2019-01-04",
        "status": "A",
        "authorized_official_last_name": "KUTTAB",
        "authorized_official_first_name": "JOHNNY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "773-423-6050"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pediatric Anesthesia Associates, LTD
• Pediatric Associates SC
• Pediatric Center of Chicago
• Pediatric Clinic LTD.
• Pediatric Dental Health Associates, LTD.
• Pediatric Developmental Center
• Pediatric Eye Consultants PC
• Pediatric Faculty Foundation, Inc
• Pediatric General Care & Research
• Pediatric General Care & Research Fund

• Pediatric Dentistry in Chicago, IL
• Providers in Chicago, IL by specialty
• Pediatric Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2019; 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.