Jefferson Park Family Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

JEFFERSON PARK FAMILY DENTAL LLC

Practice address

4452 N Central Ave
Chicago, IL 60630-3302

Phone

(773) 777-4800

Fax

(773) 777-4918

NPI assigned

Jul 8, 2021

Last updated

Jan 13, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Robert Cory Stites

Title

Insurance Coordinator-Decision One

Phone

(630) 869-5857

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michele T Bogacki, D.D.S.

  • General Practice Dentistry
  • Chicago, IL
  • NPI 1528081742
  NPD (past)

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

{
    "created_epoch": "1625702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673568000000",
    "number": "1417528589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4452 N CENTRAL AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606303302",
            "telephone_number": "773-777-4800",
            "fax_number": "773-777-4918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4452 N CENTRAL AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606303302",
            "telephone_number": "773-777-4800",
            "fax_number": "773-777-4918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON PARK FAMILY DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-08",
        "last_updated": "2023-01-13",
        "certification_date": "2023-01-13",
        "status": "A",
        "authorized_official_last_name": "STITES",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "CORY",
        "authorized_official_title_or_position": "INSURANCE COORDINATOR-DECISION ONE",
        "authorized_official_telephone_number": "630-869-5857",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeff Rager, DPM
• Jeff Rager, DPM
• Jeff Transit LLC
• Jill Starzyk Jeffe, MD
• Jefferson Park Counseling
• Jefferson Park Medical Center
• Jefferson Park Medical Center, LTD.
• Jefferson Park Medical Group, P.C.
• Tanya Jefferson-Fitts
• Serena Jefferson-Jackson

• General Practice Dentistry in Chicago, IL
• Providers in Chicago, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2023; 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.