Ico Dental, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

ICO DENTAL, LLC

Practice address

4200 W Peterson Ave Ste 136
Chicago, IL 60646-6052

Phone

(773) 286-5286

NPI assigned

Aug 9, 2022

Last updated

Aug 9, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Thaer Al Azzawi, DMD

Title

Owner

Phone

(713) 382-8654

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Irene T. Theodore, DDS

  • General Practice Dentistry
  • Chicago, IL
  • NPI 1871756767
  NPD (past)

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

{
    "created_epoch": "1660003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660003200000",
    "number": "1144958067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "343 W WOLF POINT PLZ UNIT 1404",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606540103",
            "telephone_number": "713-382-8654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 W PETERSON AVE STE 136",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606466052",
            "telephone_number": "773-286-5286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICO DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-09",
        "last_updated": "2022-08-09",
        "certification_date": "2022-08-09",
        "status": "A",
        "authorized_official_last_name": "AL AZZAWI",
        "authorized_official_first_name": "THAER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "713-382-8654",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Icc Treatment Center
• Icc Treatment Center
• Icg Home Health Care
• Icg Services, LLC (Spectrum of Smiles)
• Vicken Ichkhan, D.D.S.
• Icon Events Co
• Iconic Optical
• Icz Medical Group (Pain management center)
• Id
• Id Chicago Inc

• Dental Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Dental Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2022; 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.