NPIMap

Organization Active NPI

Mobile Medical and Dental Services, P.C.

  • Dentist
  • Chicago, IL
National Provider Identifier
1376869024
Registry record updated Apr 19, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019.021712 Issued in IL
Legal business name
MOBILE MEDICAL AND DENTAL SERVICES, P.C.
Practice address
9716 S Longwood Dr
Chicago, IL 60643-1610
Phone
(708) 250-6175
NPI assigned
Apr 19, 2010
Last updated
Apr 19, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2010

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

Authorized official

Name
Dr. William Crevier, M.D.
Title
President
Phone
(708) 250-6175

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 019.021712 IL Primary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 036.074856 IL

Addresses

Primary practice location

9716 S Longwood Dr
Chicago, IL 60643-1610

Mailing address

9716 S Longwood Dr
Chicago, IL 60643-1610
Phone (708) 250-6175

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1271635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271635200000",
    "number": "1376869024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9716 S LONGWOOD DR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606431610",
            "telephone_number": "708-250-6175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9716 S LONGWOOD DR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606431610",
            "telephone_number": "708-250-6175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE MEDICAL AND DENTAL SERVICES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-19",
        "last_updated": "2010-04-19",
        "status": "A",
        "authorized_official_last_name": "CREVIER",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-250-6175",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.021712",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.074856",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2010; 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.