NPIMap

Organization Active NPI

Dental 360 Pulaski 67 LLC

  • Dentist
  • Chicago, IL
National Provider Identifier
1235968587
Registry record updated Jul 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
DENTAL 360 PULASKI 67 LLC
Practice address
2759 W 55TH St Ste B
Chicago, IL 60632-2251
Phone
(773) 776-5277
Fax
(773) 776-5278
NPI assigned
Jul 26, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2024

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

Authorized official

Name
Mohammed Parvez
Title
Owner
Phone
(630) 294-1770

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

2759 W 55TH St Ste B
Chicago, IL 60632-2251

Mailing address

2759 W 55TH St Ste B
Chicago, IL 60632-2251
Phone (773) 776-5277

Other names 1

  • Dental 360 California Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dental 360 Armitage12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Locations

2759 W 55th St
Ste B
Chicago, IL 60632
Phone (773) 776-5277

NPI Registry JSON

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

{
    "created_epoch": "1721952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721952000000",
    "number": "1235968587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2759 W 55TH ST STE B",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606322251",
            "telephone_number": "773-776-5277",
            "fax_number": "773-776-5278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2759 W 55TH ST STE B",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606322251",
            "telephone_number": "773-776-5277",
            "fax_number": "773-776-5278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL 360 PULASKI 67 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-26",
        "last_updated": "2024-07-26",
        "certification_date": "2024-07-26",
        "status": "A",
        "authorized_official_last_name": "PARVEZ",
        "authorized_official_first_name": "MOHAMMED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-294-1770"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dental 360 California",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jul 26, 2024; 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.