NPIMap

Organization Active NPI

Dental Magic North Ave, Inc

  • General Practice Dentistry
  • Chicago, IL
National Provider Identifier
1104274109
Registry record updated May 31, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019024297 Issued in IL
Legal business name
DENTAL MAGIC NORTH AVE, INC
Practice address
2500 W North Ave
Chicago, IL 60647-5202
Phone
(773) 360-1281
Fax
(773) 360-1285
NPI assigned
May 31, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 2016

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

Authorized official

Name
Sawsan Asfour, DDS
Title
Owner
Phone
(773) 360-1281

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 019024297 IL Primary

Addresses

Primary practice location

2500 W North Ave
Chicago, IL 60647-5202

Mailing address

2500 W North Ave
Chicago, IL 60647-5202
Phone (773) 360-1281

Other names 1

  • Dental Magic 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": "1464652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464652800000",
    "number": "1104274109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 W NORTH AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606475202",
            "telephone_number": "773-360-1281",
            "fax_number": "773-360-1285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 W NORTH AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606475202",
            "telephone_number": "773-360-1281",
            "fax_number": "773-360-1285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL MAGIC NORTH AVE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-31",
        "last_updated": "2016-05-31",
        "status": "A",
        "authorized_official_last_name": "ASFOUR",
        "authorized_official_first_name": "SAWSAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-360-1281",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019024297",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dental Magic",
            "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 May 31, 2016; 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.