Periodontics & Dental Implant Center LTD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

019028531 Issued in IL

Legal business name

PERIODONTICS & DENTAL IMPLANT CENTER LTD

Practice address

1900 W 47TH St
Chicago, IL 60609-3833

Phone

(773) 847-9004

Fax

(773) 847-9008

NPI assigned

Mar 4, 2013

Organization subpart

No

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

Authorized official

Name

Amjod Aldollal, D.D.S.

Title

President

Phone

(773) 847-9004

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1362355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362355200000",
    "number": "1275874182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 W 47TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606093833",
            "telephone_number": "773-847-9004",
            "fax_number": "773-847-9008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 W 47TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606093833",
            "telephone_number": "773-847-9004",
            "fax_number": "773-847-9008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERIODONTICS & DENTAL IMPLANT CENTER LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-04",
        "last_updated": "2013-03-04",
        "status": "A",
        "authorized_official_last_name": "ALDOLLAL",
        "authorized_official_first_name": "AMJOD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-847-9004",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": "019028531",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019028531",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Chicago, IL
• Providers in Chicago, IL by specialty
• Periodontics in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2013; 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.