NPIMap

Organization Active NPI

Crescent Family Dental LLC

Doing business as Crescent Family Dental

  • Dentist
  • Wheeling, IL
National Provider Identifier
1043749286
Registry record updated Jun 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019.030051 Issued in IL
Legal business name
CRESCENT FAMILY DENTAL LLC
Doing business as
Crescent Family Dental
Practice address
307 S Milwaukee Ave Ste 101
Wheeling, IL 60090-5035
Phone
(847) 459-3366
NPI assigned
Jun 10, 2017
Last updated
Jun 25, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2020

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

Authorized official

Name
Dr. Deeptha Surampudi, DDSNPI 1831591106
Title
President
Phone
(224) 229-9688

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 019.030051 IL Primary

Addresses

Primary practice location

307 S Milwaukee Ave Ste 101
Wheeling, IL 60090-5035

Mailing address

180 Brook Hill LN
Vernon Hills, IL 60061-3142
Phone (224) 229-9688

Other names 1

  • Crescent Family Dental Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1497052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593043200000",
    "number": "1043749286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 BROOK HILL LN",
            "city": "VERNON HILLS",
            "state": "IL",
            "postal_code": "600613142",
            "telephone_number": "224-229-9688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 S MILWAUKEE AVE STE 101",
            "city": "WHEELING",
            "state": "IL",
            "postal_code": "600905035",
            "telephone_number": "847-459-3366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESCENT FAMILY DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-10",
        "last_updated": "2020-06-25",
        "certification_date": "2020-06-25",
        "status": "A",
        "authorized_official_last_name": "SURAMPUDI",
        "authorized_official_first_name": "DEEPTHA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "224-229-9688",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.030051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crescent Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wheeling, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 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.