Individual provider Active NPI

Marian Brinker, D.D.S.

  • Dentist
  • Chgo, IL
National Provider Identifier
1285969428
Registry record updated Oct 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019-023212 Issued in IL
Practice address
11606 S. Western Ave.
Chgo, IL 60643
Phone
(773) 233-0155
Fax
(773) 233-9941
NPI assigned
Oct 6, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 6, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 019-023212 IL Primary

Addresses

Primary practice location

11606 S. Western Ave.
Chgo, IL 60643

Mailing address

11606 S. Western Ave.
Chgo, IL 60643
Phone (773) 233-0155

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
019-023212ILMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Family Care Gentle Dental Ctr, P.C. Dentist Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1254787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254787200000",
    "number": "1285969428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11606 S. WESTERN AVE.",
            "city": "CHGO",
            "state": "IL",
            "postal_code": "60643",
            "telephone_number": "773-233-0155",
            "fax_number": "773-233-9941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11606 S. WESTERN AVE.",
            "city": "CHGO",
            "state": "IL",
            "postal_code": "60643",
            "telephone_number": "773-233-0155",
            "fax_number": "773-233-9941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRINKER",
        "first_name": "MARIAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-10-06",
        "last_updated": "2009-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019-023212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chgo, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2009; 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.