NPIMap

Organization Active NPI

Dental Impression, SC

  • Dentist
  • Chicago, IL
National Provider Identifier
1235415548
Registry record updated Nov 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019025521 Issued in IL
Legal business name
DENTAL IMPRESSION, SC
Practice address
5430 S Kedzie Ave
Chicago, IL 60632-2620
Phone
(773) 925-0650
NPI assigned
Nov 1, 2011
Last updated
Nov 1, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2011

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

Authorized official

Name
Dr. Shafeeq H Bader, DDSNPI 1114916129
Title
President
Phone
(630) 452-6950

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 019025521 IL Primary

Addresses

Primary practice location

5430 S Kedzie Ave
Chicago, IL 60632-2620

Mailing address

5430 S Kedzie Ave
Chicago, IL 60632-2620
Phone (773) 925-0650

National Provider Directory

National Provider Directory
Tax ID family
Dental Impression2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1320105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320105600000",
    "number": "1235415548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5430 S KEDZIE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606322620",
            "telephone_number": "773-925-0650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5430 S KEDZIE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606322620",
            "telephone_number": "773-925-0650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL IMPRESSION, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-01",
        "last_updated": "2011-11-01",
        "status": "A",
        "authorized_official_last_name": "BADER",
        "authorized_official_first_name": "SHAFEEQ",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-452-6950",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019025521",
            "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 Nov 1, 2011; 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.