Mital Spatz, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

021002694 Issued in IL

Practice address

2929 N Southport Ave
Chicago, IL 60657-6945

Phone

(773) 328-8282

Fax

(773) 328-8204

NPI assigned

Jun 4, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Nov 13, 2018 through Nov 13, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1275609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525305600000",
    "number": "1134449747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2929 N. SOUTHPORT AVE",
            "address_2": "TOOTH BUDS PEDIATRIC DENTISTRY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60657",
            "telephone_number": "773-328-8282",
            "fax_number": "773-328-8402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2929 N SOUTHPORT AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606576945",
            "telephone_number": "773-328-8282",
            "fax_number": "773-328-8204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPATZ",
        "first_name": "MITAL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-04",
        "last_updated": "2018-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019028295",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IL",
            "license": "021002694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristie Morgan Sparks, MD
• Morgan Sparks, LSW
• Brent Allen Sparlin, LCSW
• Angela Sparrock
• Violeta Spasova X, MD
• Caleb Spaulding
• Tiffani Spaulding, MD, MPH
• Speak Chicago Psychotherapy LLC
• Speak Therapy LLC
• Speak Up Chicago, Inc

• Pediatric Dentistry in Chicago, IL
• Providers in Chicago, IL by specialty
• Pediatric Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.