Individual provider Active NPI

Susan M Cholakian, DDS

  • General Practice Dentistry
  • Des Plaines, IL
National Provider Identifier
1366717464
Registry record updated Mar 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019020852 Issued in IL
Practice address
1585 Ellinwood Ave
Suite 106
Des Plaines, IL 60016-4510
Phone
(847) 803-5151
Fax
(847) 803-5491
NPI assigned
Mar 21, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 21, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 019020852 IL Primary

Addresses

Primary practice location

1585 Ellinwood Ave
Suite 106
Des Plaines, IL 60016-4510

Mailing address

1585 Ellinwood Ave
Suite 106
Des Plaines, IL 60016-4510
Phone (847) 803-5151

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
019020852ILMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1332288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332288000000",
    "number": "1366717464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1585 ELLINWOOD AVE",
            "address_2": "SUITE 106",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600164510",
            "telephone_number": "847-803-5151",
            "fax_number": "847-803-5491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1585 ELLINWOOD AVE",
            "address_2": "SUITE 106",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600164510",
            "telephone_number": "847-803-5151",
            "fax_number": "847-803-5491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHOLAKIAN",
        "first_name": "SUSAN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-03-21",
        "last_updated": "2012-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019020852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Plaines, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2012; 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.