NPIMap

Organization Active NPI

Art of Modern Dentistry Pediatrics P.C

  • Dentist
  • Chicago, IL
National Provider Identifier
1194130013
Registry record updated Jun 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019025332 Issued in IL
Legal business name
ART OF MODERN DENTISTRY PEDIATRICS P.C
Practice address
1510 S Wabash Ave
Chicago, IL 60605-2809
Phone
(312) 922-1898
Fax
(312) 922-1879
NPI assigned
Jun 30, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2014

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

Authorized official

Name
Dr. Farideh Nikoo Daftary, DDS
Title
Owner/Dentist
Phone
(312) 922-1898

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 019025332 IL Primary

Addresses

Primary practice location

1510 S Wabash Ave
Chicago, IL 60605-2809

Mailing address

1510 S Wabash Ave
Chicago, IL 60605-2809
Phone (312) 922-1898

Other identifiers 1

IdentifierTypeStateIssuer
019025332MedicaidIL

National Provider Directory

National Provider Directory
Tax ID family
Art of Modern Dentistry PC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1404086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404086400000",
    "number": "1194130013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1510 S WABASH AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606052809",
            "telephone_number": "312-922-1898",
            "fax_number": "312-922-1879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 S WABASH AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606052809",
            "telephone_number": "312-922-1898",
            "fax_number": "312-922-1879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ART OF MODERN DENTISTRY PEDIATRICS P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-30",
        "last_updated": "2014-06-30",
        "status": "A",
        "authorized_official_last_name": "DAFTARY",
        "authorized_official_first_name": "FARIDEH",
        "authorized_official_middle_name": "NIKOO",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "312-922-1898",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019025332",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019025332",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 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.