NPIMap

Organization Active NPI

Calumet Park Dental Inc.

  • Dentist
  • Calumet Park, IL
National Provider Identifier
1174994479
Registry record updated Oct 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019023113 Issued in IL
Legal business name
CALUMET PARK DENTAL INC.
Practice address
1328 W 127TH St
Calumet Park, IL 60827-6129
Phone
(708) 597-3131
Fax
(798) 597-1898
NPI assigned
Oct 13, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2015

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

Authorized official

Name
Shameema Essof
Title
President
Phone
(630) 890-3123

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 019023113 IL Primary

Addresses

Primary practice location

1328 W 127TH St
Calumet Park, IL 60827-6129

Mailing address

PO Box 179
Blue Island, IL 60406-0179
Phone (708) 597-3131

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1444694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444694400000",
    "number": "1174994479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 179",
            "city": "BLUE ISLAND",
            "state": "IL",
            "postal_code": "604060179",
            "telephone_number": "708-597-3131",
            "fax_number": "708-597-1898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1328 W 127TH ST",
            "city": "CALUMET PARK",
            "state": "IL",
            "postal_code": "608276129",
            "telephone_number": "708-597-3131",
            "fax_number": "798-597-1898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALUMET PARK DENTAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-13",
        "last_updated": "2015-10-13",
        "status": "A",
        "authorized_official_last_name": "ESSOF",
        "authorized_official_first_name": "SHAMEEMA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-890-3123"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019023113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Calumet Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2015; 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.