Independence Family Dental

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

INDEPENDENCE FAMILY DENTAL

Practice address

4703 W Lawrence Ave
Chicago, IL 60630-1722

Phone

(773) 205-9900

Fax

(773) 205-9970

NPI assigned

Dec 2, 2005

Last updated

Aug 22, 2020By 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

Emad E Azab, DDSNPI 1629247572

Title

Dentist

Phone

(773) 205-9900

Specialties & licenses 1

Addresses

Other identifiers 1

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.

• Emad E Azab, D.D.S

  • Dentist
  • Chicago, IL
  • NPI 1629247572
  Authorized official Same address or phone

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

{
    "created_epoch": "1133481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164406138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4703 W LAWRENCE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606301722",
            "telephone_number": "773-205-9900",
            "fax_number": "773-205-9970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4703 W LAWRENCE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606301722",
            "telephone_number": "773-205-9900",
            "fax_number": "773-205-9970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENCE FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "AZAB",
        "authorized_official_first_name": "EMAD",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "773-205-9900",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101611",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Inclusive Speech & Language Services LLC
• Inclusive Therapies
• Inclusive Wellness, LTD. (Soheila Vahabi DC)
• Inclusivity Counseling, LLC
• Independence Care of Chicago LLC
• Independence Home Health Services, Inc.
• Independent Living Solutions, Inc.
• Independent Physician Group of Illinois (OurHealth Physician Group)
• Independent Physicians at Mercy
• Independent Physicians' Aco of Chicago, LLC

• Dentist in Chicago, IL
• Providers in Chicago, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.