Lakeside Dental Center Inc.

Primary specialty

DentistTaxonomy code 122300000X

License

019010535 Issued in IL

Legal business name

LAKESIDE DENTAL CENTER INC.

Practice address

2218 S Michigan Ave
Chicago, IL 60616-2126

Phone

(312) 842-7133

Fax

(312) 842-2214

NPI assigned

Sep 7, 2011

Organization subpart

No

Name

Mr. Marvin Kozlov, D.D.S

Title

Owner

Phone

(312) 842-7133

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 7, 2011.

{
    "created_epoch": "1315353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315353600000",
    "number": "1407137151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2218 S MICHIGAN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606162126",
            "telephone_number": "312-842-7133",
            "fax_number": "312-842-2214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2218 S MICHIGAN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606162126",
            "telephone_number": "312-842-7133",
            "fax_number": "312-842-2214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE DENTAL CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-07",
        "last_updated": "2011-09-07",
        "status": "A",
        "authorized_official_last_name": "KOZLOV",
        "authorized_official_first_name": "MARVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-842-7133",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019010535",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lakeshorehealthcare
• Lakeside Community Committee
• Lakeside Community Committee
• Lakeside Dental Center
• Lakeside Dental Center
• Lakeside Eye Clinic Inc
• Lakeside Eye Group, S.C.
• Lakeside Medical Group LTD
• Lakeside Nephrolgoy LTD/Prarie
• Lakeside Nephrology, LTD.

• All providers in Chicago, IL
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2011; 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.