NPIMap

Organization Active NPI

Perfect Dental Smile, LTD.

  • Dentist
  • Chicago, IL
National Provider Identifier
1104077692
Registry record updated Nov 10, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019024872 Issued in IL
Legal business name
PERFECT DENTAL SMILE, LTD.
Practice address
2545 W Peterson Ave
Suite 201
Chicago, IL 60659-4091
Phone
(773) 561-2808
Fax
(773) 561-2809
NPI assigned
Oct 2, 2008
Organization subpart
Yes
Parent organization
PERFECT DENTAL SMILE, LTS.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 10, 2009

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

Authorized official

Name
Dr. Bushra Ahmed Al Azzawi, D.D.S.NPI 1730220450
Title
Dentist
Phone
(773) 561-2808

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 019024872 IL Primary

Addresses

Primary practice location

2545 W Peterson Ave
Suite 201
Chicago, IL 60659-4091

Mailing address

2545 W Peterson Ave
Suite 201
Chicago, IL 60659-4091
Phone (773) 561-2808

National Provider Directory

National Provider Directory
Tax ID family
Perfect Dental Smile LTD2 organizations share this tax ID, including this one
Part of
Perfect Dental Smile LTD

Other organizations with this tax ID 1

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

Locations

2545 W Peterson Ave
Ste 201
Chicago, IL 60659
Phone (773) 561-2808

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": "1222905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257811200000",
    "number": "1104077692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2545 W PETERSON AVE",
            "address_2": "SUITE 201",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606594091",
            "telephone_number": "773-561-2808",
            "fax_number": "773-561-2809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2545 W PETERSON AVE",
            "address_2": "SUITE 201",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606594091",
            "telephone_number": "773-561-2808",
            "fax_number": "773-561-2809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERFECT DENTAL SMILE, LTD.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PERFECT DENTAL SMILE, LTS.",
        "enumeration_date": "2008-10-02",
        "last_updated": "2009-11-10",
        "status": "A",
        "authorized_official_last_name": "AL AZZAWI",
        "authorized_official_first_name": "BUSHRA",
        "authorized_official_middle_name": "AHMED",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "773-561-2808",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019024872",
            "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 Nov 10, 2009; 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.