NPIMap

Organization Active NPI

Dental 360 Pulaski 67 LLC

Doing business as Dental 360 Clark

  • Dentist
  • Chicago, IL
National Provider Identifier
1386473619
Registry record updated Jul 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
DENTAL 360 PULASKI 67 LLC
Doing business as
Dental 360 Clark
Practice address
6720 N Clark St Ste B
Chicago, IL 60626-3211
Phone
(773) 338-8470
Fax
(773) 338-8471
NPI assigned
Jul 26, 2024
Last updated
Jul 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2024

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

Authorized official

Name
Mohammed Parvez, DMDNPI 1265786719
Title
Owner
Phone
(630) 294-1770

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

6720 N Clark St Ste B
Chicago, IL 60626-3211

Mailing address

6720 N Clark St Ste B
Chicago, IL 60626-3211
Phone (773) 338-8470

Other names 1

  • Dental 360 Clark Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dental 360 Armitage12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6720 N Clark St
Ste B
Chicago, IL 60626
Phone (773) 338-8470

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1721952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721952000000",
    "number": "1386473619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6720 N CLARK ST STE B",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606263211",
            "telephone_number": "773-338-8470",
            "fax_number": "773-338-8471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6720 N CLARK ST STE B",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606263211",
            "telephone_number": "773-338-8470",
            "fax_number": "773-338-8471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL 360 PULASKI 67 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-26",
        "last_updated": "2024-07-26",
        "certification_date": "2024-07-26",
        "status": "A",
        "authorized_official_last_name": "PARVEZ",
        "authorized_official_first_name": "MOHAMMED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-294-1770",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dental 360 Clark",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jul 26, 2024; 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.