NPIMap

Organization Active NPI

John J Dzakovich DDS LTD

  • Clinic/Center
  • Maywood, IL
National Provider Identifier
1245634534
Registry record updated Oct 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
019.016695 Issued in IL
Legal business name
JOHN J DZAKOVICH DDS LTD
Practice address
1409 S 5TH Ave
Maywood, IL 60153-2128
Phone
(708) 865-2225
NPI assigned
Oct 15, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2014

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

Authorized official

Name
Dr. James Poulos, DDS
Title
President
Phone
(708) 865-2225

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 019.016695 IL Primary

Addresses

Primary practice location

1409 S 5TH Ave
Maywood, IL 60153-2128

Mailing address

1409 S 5TH Ave
Maywood, IL 60153-2128
Phone (708) 865-2225

Other names 1

  • Maywood Family Dental ltd Doing business as

National Provider Directory

National Provider Directory
Tax ID family
John J Dzakovich DDS LTD3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1413331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413331200000",
    "number": "1245634534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1409 S 5TH AVE",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601532128",
            "telephone_number": "708-865-2225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 S 5TH AVE",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601532128",
            "telephone_number": "708-865-2225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN J DZAKOVICH DDS LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-15",
        "last_updated": "2014-10-15",
        "status": "A",
        "authorized_official_last_name": "POULOS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-865-2225",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IL",
            "license": "019.016695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maywood Family Dental ltd",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maywood, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2014; 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.