NPIMap

Organization Active NPI

Metro Kidz Dental, PC

  • Pediatric Dentistry
  • Dolton, IL
National Provider Identifier
1063836567
Registry record updated Feb 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
019027333 Issued in IL
Legal business name
METRO KIDZ DENTAL, PC
Practice address
808 E Sibley Blvd
Dolton, IL 60419-2130
Phone
(847) 987-0322
NPI assigned
Feb 5, 2014
Last updated
Feb 5, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2014

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

Authorized official

Name
Scott Goldman
Title
President
Phone
(847) 987-0322

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 019027333 IL Primary

Addresses

Primary practice location

808 E Sibley Blvd
Dolton, IL 60419-2130

Mailing address

808 E Sibley Blvd
Dolton, IL 60419-2130

National Provider Directory

National Provider Directory
Tax ID family
Metro Kidz Dental PC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

808 E Sibley Blvd
Dolton, IL 60419
Phone (708) 499-0100

NPI Registry JSON

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

{
    "created_epoch": "1391558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391558400000",
    "number": "1063836567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 E SIBLEY BLVD",
            "city": "DOLTON",
            "state": "IL",
            "postal_code": "604192130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 E SIBLEY BLVD",
            "city": "DOLTON",
            "state": "IL",
            "postal_code": "604192130",
            "telephone_number": "847-987-0322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METRO KIDZ DENTAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-05",
        "last_updated": "2014-02-05",
        "status": "A",
        "authorized_official_last_name": "GOLDMAN",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-987-0322"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IL",
            "license": "019027333",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dolton, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2014; 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.