Clark Dental Office LTD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

CLARK DENTAL OFFICE LTD

Practice address

6210 N Clark St
Chicago, IL 60660

Phone

(773) 761-2020

Fax

(773) 761-2072

NPI assigned

Mar 24, 2008

Organization subpart

No

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

Authorized official

Name

Reza Jalili Kmoshnood, DMD

Title

President Dentist

Phone

(773) 761-2020

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Reza J Khoshnood, D.M.D.

  • General Practice Dentistry
  • Chicago, IL
  • NPI 1447399126
  NPD (past)

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

{
    "created_epoch": "1206316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206316800000",
    "number": "1316119993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6210 N CLARK ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60660",
            "telephone_number": "773-761-2020",
            "fax_number": "773-761-2072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6210 N CLARK ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60660",
            "telephone_number": "773-761-2020",
            "fax_number": "773-761-2072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK DENTAL OFFICE LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-24",
        "last_updated": "2008-03-24",
        "status": "A",
        "authorized_official_last_name": "KMOSHNOOD",
        "authorized_official_first_name": "REZA",
        "authorized_official_middle_name": "JALILI",
        "authorized_official_title_or_position": "PRESIDENT DENTIST",
        "authorized_official_telephone_number": "773-761-2020",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1002509",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leticia F Claridad, MD
• Claridge Imperial, LTD
• Claridge Ivy, LTD
• Clarion Voice & Speech PLLC
• Clarity Clinic PLLC
• Clark Manor Convalescent Center, Inc
• Clark Pharmacy Inc
• Clark Skilled Nursing Facility LLC
• Allison Clark Young, APN
• Cynthia June Clark-Bumgarner, CRNA

• General Practice Dentistry in Chicago, IL
• Providers in Chicago, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2008; 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.