NPIMap

Organization Active NPI

Chicago Family Dental Center PC

  • General Practice Dentistry
  • Chicago, IL
National Provider Identifier
1104047091
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
CHICAGO FAMILY DENTAL CENTER PC
Practice address
55 E Washington St Ste 2141
Chicago, IL 60602-2294
Phone
(312) 551-0500
Fax
(312) 372-0165
NPI assigned
May 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Gary George Wegmann
Title
President
Phone
(312) 551-0500

Specialties & licenses 1

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

Addresses

Primary practice location

55 E Washington St Ste 2141
Chicago, IL 60602-2294

Mailing address

55 E Washington St Ste 2141
Chicago, IL 60602-2294
Phone (312) 551-0500

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104047091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 E WASHINGTON ST STE 2141",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606022294",
            "telephone_number": "312-551-0500",
            "fax_number": "312-372-0165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 E WASHINGTON ST STE 2141",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606022294",
            "telephone_number": "312-551-0500",
            "fax_number": "312-372-0165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICAGO FAMILY DENTAL CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WEGMANN",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "GEORGE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "312-551-0500",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Aug 22, 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.