NPIMap

Organization Active NPI

Compass Dental, P.C.

  • General Practice Dentistry
  • Chicago, IL
National Provider Identifier
1104174374
Registry record updated Aug 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
COMPASS DENTAL, P.C.
Practice address
4413 N Clark St
Chicago, IL 60640-5403
Phone
(785) 979-5147
NPI assigned
Aug 20, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2012

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

Authorized official

Name
Dr. Brandon Prusa, D.D.S.
Title
President
Phone
(785) 979-5147

Specialties & licenses 1

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

Addresses

Primary practice location

4413 N Clark St
Chicago, IL 60640-5403

Mailing address

2348 N Lister Ave
#407
Chicago, IL 60614-2994
Phone (785) 979-5147

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1345420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345420800000",
    "number": "1104174374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2348 N LISTER AVE",
            "address_2": "#407",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606142994",
            "telephone_number": "785-979-5147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4413 N CLARK ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405403",
            "telephone_number": "785-979-5147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPASS DENTAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-20",
        "last_updated": "2012-08-20",
        "status": "A",
        "authorized_official_last_name": "PRUSA",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "785-979-5147",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "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 20, 2012; 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.