NPIMap

Organization Active NPI

McLean Dental Clinic, P.C.

  • Dental Clinic/Center
  • Elgin, IL
National Provider Identifier
1295122539
Registry record updated Apr 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
019022632 Issued in IL
Legal business name
MCLEAN DENTAL CLINIC, P.C.
Practice address
552 N McLean Blvd
Elgin, IL 60123-3242
Phone
(847) 931-9744
Fax
(847) 931-7726
NPI assigned
Apr 24, 2015
Last updated
Apr 24, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2015

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

Authorized official

Name
Dr. Mumtaz Siddique, D.D.S., M.SC.NPI 1124120381
Title
Doctor
Phone
(847) 931-9744

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 019022632 IL Primary

Addresses

Primary practice location

552 N McLean Blvd
Elgin, IL 60123-3242

Mailing address

552 N McLean Blvd
Elgin, IL 60123-3242
Phone (847) 931-9744

Other identifiers 1

IdentifierTypeStateIssuer
019022632MedicaidIL

National Provider Directory

National Provider Directory
Tax ID family
McLean Dental Clinic PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1429833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429833600000",
    "number": "1295122539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "552 N MCLEAN BLVD",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601233242",
            "telephone_number": "847-931-9744",
            "fax_number": "847-931-7726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "552 N MCLEAN BLVD",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601233242",
            "telephone_number": "847-931-9744",
            "fax_number": "847-931-7726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLEAN DENTAL CLINIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-24",
        "last_updated": "2015-04-24",
        "status": "A",
        "authorized_official_last_name": "SIDDIQUE",
        "authorized_official_first_name": "MUMTAZ",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "847-931-9744",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S., M.SC."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": "019022632",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019022632",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elgin, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2015; 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.