Titan Dental PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019029975 Issued in IL

Legal business name

TITAN DENTAL PC

Doing business as

TruBlu Dentistry

Practice address

13247 S Baltimore Ave
Chicago, IL 60633-1431

Phone

(773) 646-4664

NPI assigned

Aug 21, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Abhishek Nagaraj, DDSNPI 1154739571

Title

Owner

Phone

(312) 384-9493

Specialties & licenses 1

Addresses

Other names 1

• TruBlu Dentistry Doing business as

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.

• Abhishek Nagaraj, DDS

  • General Practice Dentistry
  • Chicago, IL
  • NPI 1154739571
  NPD Authorized official

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

{
    "created_epoch": "1503273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503273600000",
    "number": "1316463375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 N CLARK ST UNIT I",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606108702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13247 S BALTIMORE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606331431",
            "telephone_number": "773-646-4664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TITAN DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-21",
        "last_updated": "2017-08-21",
        "status": "A",
        "authorized_official_last_name": "NAGARAJ",
        "authorized_official_first_name": "ABHISHEK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-384-9493",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019029975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TruBlu Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Courtland Benjamin Tisdale, PH.D.
• Kyndria Tisdale
• Austin Joseph Tisdell, DO
• Emily Anne Tisma, MD
• Alexander Tisman, LCSW
• Tito Go Yao MD SC
• Lisett Tito, LCSW
• Nicole A Tito, DPT
• Haley Titus, PHD
• Joshua Thomas Titus, PHARM.D.

• 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 Aug 21, 2017; 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.