Kedzie 47 Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

KEDZIE 47 DENTAL LLC

Doing business as

Kedzie47 Dental

Practice address

4721 S Kedzie Ave
Chicago, IL 60632-3001

Phone

(773) 847-4444

Fax

(630) 359-4933

NPI assigned

Jul 23, 2020

Organization subpart

No

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

Authorized official

Name

Muzaffar Mirza, DDS

Title

President

Phone

(630) 501-0064

Specialties & licenses 2

Addresses

Other names 1

• Kedzie47 Dental Doing business as

Electronic endpoints 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gaurav Aidasani

  • General Practice Dentistry
  • Chicago, IL
  • NPI 1083394704
  NPD
• Eiman Omer Ahmed Osman, DDS

  • Dentist
  • Chicago, IL
  • NPI 1598641516
  NPD
• Rafia Nawab Jabeen, DMD

  • Dentist
  • Summit, IL
  • NPI 1023889466
  NPD (past)
• Sarah Qazi

  • Dentist
  • Villa Park, IL
  • NPI 1740889591
  NPD (past)
• Praneeta Thakur, DMD

  • Dentist
  • Chicago, IL
  • NPI 1275186173
  NPD (past)

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

{
    "created_epoch": "1595462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635379200000",
    "number": "1144839424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4721 S KEDZIE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606323001",
            "telephone_number": "630-501-0064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4721 S KEDZIE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606323001",
            "telephone_number": "773-847-4444",
            "fax_number": "630-359-4933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEDZIE 47 DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-23",
        "last_updated": "2021-10-28",
        "certification_date": "2021-10-28",
        "status": "A",
        "authorized_official_last_name": "MIRZA",
        "authorized_official_first_name": "MUZAFFAR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-501-0064",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kedzie47@mirzadental.com",
            "affiliation": "N",
            "address_1": "4719 S Kedzie Ave",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606323001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Kedzie47 Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kedzie47 Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Taylor A Keating, PA-C
• Rediet Getu Kebede, MD
• Tanya Kechker, O.D.
• Sabrina Marie Keck, D.P.T.
• Susan A. Kecskes, M.D.
• Kedzie Dental Clinic
• Kedzie Dentistry LLC
• Kedzie Drugs Inc
• Kedzie Medical Clinic Inc
• Anna Kedzierska

• General Practice Dentistry in Chicago, IL
• Providers in Chicago, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2021; 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.