Active NPI
Dominica Portman, D.M.D.
- Dentist
- North Chicago, IL
National Provider Identifier
1396115283
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 30.024585
- Practice address
- 3001 Green Bay Road
North Chicago, IL 60064 - Phone
- (847) 688-1900
- NPI assigned
- Oct 5, 2015
- Sex
- Female
- Sole proprietor
- No
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 | 30.024585 | OH | Primary |
Addresses
Primary practice location
3001 Green Bay Road
North Chicago, IL 60064
Mailing address
998 Church Street
Unit 212
Glenview, IL 60025
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 |
|---|---|---|---|
| 30.024585 | OH | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1444003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1444003200000",
"number": "1396115283",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "998 CHURCH STREET",
"address_2": "UNIT 212",
"city": "GLENVIEW",
"state": "IL",
"postal_code": "60025"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3001 GREEN BAY ROAD",
"city": "NORTH CHICAGO",
"state": "IL",
"postal_code": "60064",
"telephone_number": "847-688-1900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORTMAN",
"first_name": "DOMINICA",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-10-05",
"last_updated": "2015-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "30.024585",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.