Active NPI
Juan G Mesa, DDS
- Dentist
- Chicago, IL
National Provider Identifier
1386813897
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- Practice address
- 3190 N Elston Ave
Chicago, IL 60618-5845 - Phone
- (773) 267-9777
- Fax
- (773) 267-9662
- NPI assigned
- Feb 28, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | IN | Primary |
Addresses
Primary practice location
3190 N Elston Ave
Chicago, IL 60618-5845
Mailing address
3190 N Elston Ave
Chicago, IL 60618-5845
Phone (773) 267-9777
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019025977 | IN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1204156800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204156800000",
"number": "1386813897",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3190 N ELSTON AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606185845",
"telephone_number": "773-267-9777",
"fax_number": "773-267-9662"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3190 N ELSTON AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606185845",
"telephone_number": "773-267-9777",
"fax_number": "773-267-9662"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MESA",
"first_name": "JUAN",
"middle_name": "G",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-02-28",
"last_updated": "2008-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IN",
"license": null,
"primary": true
}
],
"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 Feb 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.