Individual provider Active NPI

Vida Soltani Shirazi, DDS

  • General Practice Dentistry
  • Chicago, IL
National Provider Identifier
1033792437
Registry record updated May 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019.032939 Issued in IL
Practice address
2101 E 71St St Ste C
Chicago, IL 60649-2119
Phone
(708) 386-4800
NPI assigned
May 3, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 019.032939 IL Primary

Addresses

Primary practice location

2101 E 71St St Ste C
Chicago, IL 60649-2119

Mailing address

137 N Oak Park Ave Ste 302a
Oak Park, IL 60301-1339

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210527001099 IL Order and Referring Only - DentistPractitioner - Dentist 3476952250

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019.032939ILMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
D2 Dental of Illinois, P.C. General Practice PastSince May 9, 2021 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1620000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620000000000",
    "number": "1033792437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "137 N OAK PARK AVE STE 302A",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603011339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 E 71ST ST STE C",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606492119",
            "telephone_number": "708-386-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOLTANI SHIRAZI",
        "first_name": "VIDA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-03",
        "last_updated": "2021-05-03",
        "certification_date": "2021-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.032939",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.