A-Denta Care Specialist PC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

021001402 Issued in IL

Legal business name

A-DENTA CARE SPECIALIST PC

Practice address

5780 N Lincoln Ave
Chicago, IL 60659-4721

Phone

(773) 769-1754

Fax

(773) 769-1370

NPI assigned

Mar 23, 2012

Organization subpart

No

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

Authorized official

Name

Dr. John Dimoulis, DDS MS

Title

Owner

Phone

(773) 769-1754

Specialties & licenses 3

Addresses

Other identifiers 3

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

{
    "created_epoch": "1332460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332460800000",
    "number": "1417223470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5780 N LINCOLN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606594721",
            "telephone_number": "773-769-1754",
            "fax_number": "773-769-1370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5780 N LINCOLN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606594721",
            "telephone_number": "773-769-1754",
            "fax_number": "773-769-1370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A-DENTA CARE SPECIALIST PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-23",
        "last_updated": "2012-03-23",
        "status": "A",
        "authorized_official_last_name": "DIMOULIS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-769-1754",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS MS"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": "IL",
            "license": "021002414",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": "IL",
            "license": "021002411",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": "021001402",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI DENTAL PROVIDER",
            "identifier": "1619133345",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI DENTAL PROVIDER",
            "identifier": "136645657",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL PROVIDER",
            "identifier": "1962592865",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Chicago, IL
• Providers in Chicago, IL by specialty
• Periodontics in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2012; 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.