NPIMap

Organization Active NPI

1St Family Dental of la Grange Park, PC

  • Dentist
  • La Grange Park, IL
National Provider Identifier
1154749240
Registry record updated Apr 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
1ST FAMILY DENTAL OF LA GRANGE PARK, PC
Practice address
1103 E 31St St
La Grange Park, IL 60526-1280
Phone
(708) 579-5824
NPI assigned
Apr 4, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2014

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

Authorized official

Name
Mrs. Vesna Belkic
Title
Chief Operating Officer
Phone
(773) 340-8318

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

1103 E 31St St
La Grange Park, IL 60526-1280

Mailing address

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

National Provider Directory

National Provider Directory

Locations

1103 E 31st St
La Grange Pk, IL 60526
Phone (708) 579-5824

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1396569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396569600000",
    "number": "1154749240",
    "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": "1103 E 31ST ST",
            "city": "LA GRANGE PARK",
            "state": "IL",
            "postal_code": "605261280",
            "telephone_number": "708-579-5824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1ST FAMILY DENTAL OF LA GRANGE PARK, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-04",
        "last_updated": "2014-04-04",
        "status": "A",
        "authorized_official_last_name": "BELKIC",
        "authorized_official_first_name": "VESNA",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "773-340-8318",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Grange Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2014; 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.