Fullerton Dental Island LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

FULLERTON DENTAL ISLAND LLC

Practice address

5205 W Fullerton Ave
Chicago, IL 60639-1401

Phone

(312) 709-1722

NPI assigned

Apr 9, 2024

Organization subpart

No

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

Authorized official

Name

Wisam Musa, DDSNPI 1487110029

Title

Owner

Phone

(312) 709-1722

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Wisam Musa

  • General Practice Dentistry
  • Chicago, IL
  • NPI 1487110029
  NPD Authorized official

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

{
    "created_epoch": "1712620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712620800000",
    "number": "1265285167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5836 W 100TH PL",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604533774",
            "telephone_number": "312-709-1722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5205 W FULLERTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606391401",
            "telephone_number": "312-709-1722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULLERTON DENTAL ISLAND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-09",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A",
        "authorized_official_last_name": "MUSA",
        "authorized_official_first_name": "WISAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-709-1722",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lashonda Fuller, PH.D.
• Lindsay Fuller
• Mary-Bianca Gabrielle Fuller
• Michael Alan Fuller, MD
• Rachel Marie Fuller, PT, DPT
• Fullerton Drake Medical Center
• Fullerton Family Dentistry, LTD
• Fullerton Kedzie Professional Pharmacy
• Fullerton Kimball Medical & Surgical Center
• Fullerton Kimball Medical Group SC

• General Practice Dentistry in Chicago, IL
• Providers in Chicago, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 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.