NPIMap

Organization Active NPI

Innovative Dental Group, LLC

  • Dentist
  • Chicago, IL
National Provider Identifier
1235444639
Registry record updated Aug 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
INNOVATIVE DENTAL GROUP, LLC
Practice address
20 E Washington St
Suite 1300
Chicago, IL 60602
Phone
(312) 368-6400
NPI assigned
Aug 10, 2010
Last updated
Aug 10, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2010

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

Authorized official

Name
Dimple Tejani
Title
Member
Phone
(312) 368-6400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X Primary

Addresses

Primary practice location

20 E Washington St
Suite 1300
Chicago, IL 60602

Mailing address

20 E Washington St
Suite 1300
Chicago, IL 60602
Phone (312) 368-6400

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1281398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281398400000",
    "number": "1235444639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 E WASHINGTON ST",
            "address_2": "SUITE 1300",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60602",
            "telephone_number": "312-368-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 E WASHINGTON ST",
            "address_2": "SUITE 1300",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60602",
            "telephone_number": "312-368-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE DENTAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-10",
        "last_updated": "2010-08-10",
        "status": "A",
        "authorized_official_last_name": "TEJANI",
        "authorized_official_first_name": "DIMPLE",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "312-368-6400"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "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 Aug 10, 2010; 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.