NPIMap

Organization Active NPI

Skyline Smiles LLC

  • General Practice Dentistry
  • Chicago, IL
National Provider Identifier
1093057556
Registry record updated Mar 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019027964 Issued in IL
Legal business name
SKYLINE SMILES LLC
Doing business as
Skyline Smiles
Practice address
1017 W Madison St
Chicago, IL 60607
Phone
(312) 759-1120
NPI assigned
Mar 22, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2013

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

Authorized official

Name
Dr. Deepak Joseph Neduvelil, DDS
Title
Owner
Phone
(612) 710-3883

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 019027964 IL Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 019027966 IL

Addresses

Primary practice location

1017 W Madison St
Chicago, IL 60607

Mailing address

1017 W Madison St
Chicago, IL 60607
Phone (312) 759-1120

Other names 1

  • Skyline Smiles Doing business as

National Provider Directory

National Provider Directory

Locations

1017 W Madison St
Chicago, IL 60607
Phone (312) 759-1120

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1363910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363910400000",
    "number": "1093057556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1017 W MADISON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60607",
            "telephone_number": "312-759-1120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1017 W MADISON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60607",
            "telephone_number": "312-759-1120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKYLINE SMILES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-22",
        "last_updated": "2013-03-22",
        "status": "A",
        "authorized_official_last_name": "NEDUVELIL",
        "authorized_official_first_name": "DEEPAK",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-710-3883",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019027964",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019027966",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Skyline Smiles",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Mar 22, 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.