NPIMap

Organization Active NPI

Juan G Mesa, DDS PC

  • Dentist
  • Chicago, IL
National Provider Identifier
1114022191
Registry record updated Feb 28, 2008
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Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
JUAN G MESA, DDS PC
Practice address
3190 N Elston Ave
Chicago, IL 60618-5845
Phone
(773) 267-9777
Fax
(773) 267-9662
NPI assigned
Sep 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2008

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

Authorized official

Name
Dr. Juan G Mesa, DDS
Title
Doctor Dentist
Phone
(773) 267-9777

Specialties & licenses 1

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

Addresses

Primary practice location

3190 N Elston Ave
Chicago, IL 60618-5845

Mailing address

3190 N Elston Ave
Chicago, IL 60618-5845
Phone (773) 267-9777

Other names 1

  • None Former legal business name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204156800000",
    "number": "1114022191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3190 N ELSTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606185845",
            "telephone_number": "773-267-9777",
            "fax_number": "773-267-9662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3190 N ELSTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606185845",
            "telephone_number": "773-267-9777",
            "fax_number": "773-267-9662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUAN G MESA, DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2008-02-28",
        "status": "A",
        "authorized_official_last_name": "MESA",
        "authorized_official_first_name": "JUAN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "DOCTOR DENTIST",
        "authorized_official_telephone_number": "773-267-9777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "None",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 28, 2008; 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.