Belmont Dental P.C.

Primary specialty

DentistTaxonomy code 122300000X

License

019017695 Issued in IL

Legal business name

BELMONT DENTAL P.C.

Practice address

5611 W. Belmont Ave.
Chicago, IL 60634

Phone

(773) 887-5432

Fax

(773) 417-4684

NPI assigned

Sep 14, 2009

Organization subpart

No

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

Authorized official

Name

Robert Arthur Sandusky, DDS

Title

President

Phone

(847) 470-0240

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1252886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480896000000",
    "number": "1205169802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5611 W. BELMONT AVE.",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60634",
            "telephone_number": "773-887-5432",
            "fax_number": "773-417-4684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5611 W. BELMONT AVE.",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60634",
            "telephone_number": "773-887-5432",
            "fax_number": "773-417-4684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BELMONT DENTAL P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-14",
        "last_updated": "2016-12-05",
        "status": "A",
        "authorized_official_last_name": "SANDUSKY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "ARTHUR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-470-0240",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019017695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Belmont Harlem Anesthesia LLC
• Belmont Medical & Dental Management P.C.

• 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 Dec 5, 2016; 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.