Dr Sam DMD PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

019030498 Issued in IL

Legal business name

DR SAM DMD PC

Doing business as

162nd Street Dental

Practice address

1022 E 162ND St
South Holland, IL 60473-2560

Phone

(312) 493-6089

NPI assigned

Apr 6, 2017

Organization subpart

No

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

Authorized official

Name

Samuel Osobu

Title

President

Phone

(312) 493-6089

Specialties & licenses 1

Addresses

Other names 1

• 162nd Street Dental Doing business as

Locations

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

{
    "created_epoch": "1491436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491436800000",
    "number": "1366975419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2120 W WASHINGTON BLVD",
            "address_2": "SUITE. 306",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606122346",
            "telephone_number": "312-493-6089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1022 E 162ND ST",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604732560",
            "telephone_number": "312-493-6089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR SAM DMD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-06",
        "last_updated": "2017-04-06",
        "status": "A",
        "authorized_official_last_name": "OSOBU",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "312-493-6089"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": "019030498",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "162nd Street Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dental Clinic/Center in South Holland, IL
• Providers in South Holland, IL by specialty
• Dental Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 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.