Individual provider Active NPI

Carlos A Pera, DDS

  • Public Health Dentistry
  • Chicago, IL
National Provider Identifier
1417067117
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health DentistryTaxonomy code 1223D0001X
Practice address
333 S State St
Revenue #200
Chicago, IL 60604
Phone
(312) 747-9443
Fax
(312) 747-9447
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health Dentistry 1223D0001X IL Primary

Addresses

Primary practice location

333 S State St
Revenue #200
Chicago, IL 60604

Mailing address

333 S State St
Revenue #200
Chicago, IL 60604
Phone (312) 747-9443

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

LicenseStateTypeSpecialty
019016233ILMDPublic Health Dentist

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1417067117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 S STATE ST",
            "address_2": "REVENUE #200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60604",
            "telephone_number": "312-747-9443",
            "fax_number": "312-747-9447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 S STATE ST",
            "address_2": "REVENUE #200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60604",
            "telephone_number": "312-747-9443",
            "fax_number": "312-747-9447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERA",
        "first_name": "CARLOS",
        "middle_name": "A",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "IL",
            "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 Jul 8, 2007; 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.