NPIMap

Organization Active NPI

Familia Dental Springfield 2 LLC

  • Dentist
  • Springfield, IL
National Provider Identifier
1104109230
Registry record updated Sep 26, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019026920 Issued in IL
Legal business name
FAMILIA DENTAL SPRINGFIELD 2 LLC
Practice address
802 N 9TH St
Springfield, IL 62702-6309
Phone
(888) 988-4066
Fax
(847) 496-7202
NPI assigned
Sep 26, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2011

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

Authorized official

Name
Dr. Koushan H Azad, DMD
Title
President
Phone
(888) 988-4066

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 019026920 IL Primary

Addresses

Primary practice location

802 N 9TH St
Springfield, IL 62702-6309

Mailing address

2050 E Algonquin Rd
Suite 610
Schaumburg, IL 60173-4144
Phone (888) 988-4066

Other names 1

  • FAMILIA DENTAL Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1316995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316995200000",
    "number": "1104109230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 E ALGONQUIN RD",
            "address_2": "SUITE 610",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601734144",
            "telephone_number": "888-988-4066",
            "fax_number": "847-496-7202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 N 9TH ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627026309",
            "telephone_number": "888-988-4066",
            "fax_number": "847-496-7202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILIA DENTAL SPRINGFIELD 2 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-26",
        "last_updated": "2011-09-26",
        "status": "A",
        "authorized_official_last_name": "H AZAD",
        "authorized_official_first_name": "KOUSHAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "888-988-4066",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019026920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAMILIA DENTAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2011; 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.