NPIMap

Organization Active NPI

1St Family Dental of Pulaski PC

  • Dentist
  • Chicago, IL
National Provider Identifier
1104364769
Registry record updated Feb 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019023616 Issued in IL
Legal business name
1ST FAMILY DENTAL OF PULASKI PC
Practice address
4707 N Pulaski Rd
Chicago, IL 60630-4312
Phone
(773) 279-9977
NPI assigned
Feb 3, 2017
Last updated
Feb 3, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2017

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

Authorized official

Name
Vesna Belkic
Title
Coo
Phone
(773) 340-8318

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 019023616 IL Primary

Addresses

Primary practice location

4707 N Pulaski Rd
Chicago, IL 60630-4312

Mailing address

4901 N Kedzie Ave
Chicago, IL 60625-5009
Phone (773) 340-8318

National Provider Directory

National Provider Directory

Locations

4901 N Kedzie Ave
Chicago, IL 60625
Phone (630) 300-3400

NPI Registry JSON

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

{
    "created_epoch": "1486080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486080000000",
    "number": "1104364769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4901 N KEDZIE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606255009",
            "telephone_number": "773-340-8318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4707 N PULASKI RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606304312",
            "telephone_number": "773-279-9977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1ST FAMILY DENTAL OF PULASKI PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-03",
        "last_updated": "2017-02-03",
        "status": "A",
        "authorized_official_last_name": "BELKIC",
        "authorized_official_first_name": "VESNA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "773-340-8318"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019023616",
            "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 Feb 3, 2017; 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.