Active NPI
Mohammed D. Kashmoula, DMD
- Dentist
- Calumet City, IL
National Provider Identifier
1306338199
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019.031622
- Practice address
- 1514 Torrence Ave
Calumet City, IL 60409 - Phone
- (708) 891-8569
- NPI assigned
- Jun 6, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019.031622 | IL | Primary |
Addresses
Primary practice location
1514 Torrence Ave
Calumet City, IL 60409
Mailing address
PO Box 860036
Minneapolis, MN 55486-0036
Phone (708) 891-8569
Other practice location 1
5917 S Pulaski Rd
Chicago, IL 60629-4515
Phone (773) 735-8353
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
| License | State | Type | Specialty |
|---|---|---|---|
| 019.031622 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Meckler Dental Providers (River Oaks), LTD. | 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.
-
- General Practice Dentistry
- Calumet City, IL
- NPI 1235101866
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529107200000",
"number": "1306338199",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 860036",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554860036",
"telephone_number": "708-891-8569"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1514 TORRENCE AVE",
"city": "CALUMET CITY",
"state": "IL",
"postal_code": "60409",
"telephone_number": "708-891-8569"
}
],
"practiceLocations": [
{
"address_1": "5917 S Pulaski Rd",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "606294515",
"country_code": "US",
"telephone_number": "773-735-8353",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KASHMOULA",
"first_name": "MOHAMMED",
"middle_name": "D.",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-06",
"last_updated": "2018-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019.031622",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Calumet City, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.