Edison Park Smiles,LTD

Primary specialty

DentistTaxonomy code 122300000X

License

019025308 Issued in IL

Legal business name

EDISON PARK SMILES,LTD

Practice address

6426 N Northwest Hwy
Chicago, IL 60631-1450

Phone

(773) 631-5200

NPI assigned

Nov 4, 2016

Last updated

Nov 4, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Darren Dwain Simpson, DDS

Title

Owner

Phone

(708) 369-4076

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1478217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478217600000",
    "number": "1285186411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6426 N NORTHWEST HWY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606311450",
            "telephone_number": "773-631-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6426 N NORTHWEST HWY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606311450",
            "telephone_number": "773-631-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDISON PARK SMILES,LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-04",
        "last_updated": "2016-11-04",
        "status": "A",
        "authorized_official_last_name": "SIMPSON",
        "authorized_official_first_name": "DARREN",
        "authorized_official_middle_name": "DWAIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-369-4076",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019025308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2016; 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.