Organization Active NPI

Tooth Fairy Dental PC

  • General Practice Dentistry
  • Chicago, IL
National Provider Identifier
1194998401
Registry record updated Apr 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
TOOTH FAIRY DENTAL PC
Practice address
333 W. North Ave
Chicago, IL 60610
Phone
(312) 751-1113
Fax
(312) 751-1116
NPI assigned
Apr 8, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2008

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

Authorized official

Name
Sasa Stojanovic, DDS
Title
General Dentist
Phone
(312) 751-1113

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X IL Primary

Addresses

Primary practice location

333 W. North Ave
Chicago, IL 60610

Mailing address

333 W North Ave
Chicago, IL 60610-1293
Phone (312) 751-1113

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1207612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207612800000",
    "number": "1194998401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 W NORTH AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606101293",
            "telephone_number": "312-751-1113",
            "fax_number": "312-751-1116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 W. NORTH AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60610",
            "telephone_number": "312-751-1113",
            "fax_number": "312-751-1116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOOTH FAIRY DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-08",
        "last_updated": "2008-04-08",
        "status": "A",
        "authorized_official_last_name": "STOJANOVIC",
        "authorized_official_first_name": "SASA",
        "authorized_official_title_or_position": "GENERAL DENTIST",
        "authorized_official_telephone_number": "312-751-1113",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Apr 8, 2008; 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.