NPIMap

Organization Active NPI

Panos Dentistry Center Inc.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Chicago, IL
National Provider Identifier
1447568977
Registry record updated Sep 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
021-000547 Issued in IL
Legal business name
PANOS DENTISTRY CENTER INC.
Practice address
4849 N. Milwaukee Ave
Suite 103
Chicago, IL 60630-2171
Phone
(773) 577-2100
NPI assigned
Sep 17, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2010

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

Authorized official

Name
Ms. Sue Pelletier
Title
Admin Assistance
Phone
(773) 577-2100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 019-020397 IL
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223X0400X 021-000547 IL Primary

Addresses

Primary practice location

4849 N. Milwaukee Ave
Suite 103
Chicago, IL 60630-2171

Mailing address

4849 N. Milwaukee Ave
Suite 103
Chicago, IL 60630-2171
Phone (773) 577-2100

Other identifiers 1

IdentifierTypeStateIssuer
1104979533OtherILNATIONAL PROVIDER NUMBER

National Provider Directory

National Provider Directory
Tax ID family
Panos Dentistry Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4849 N Milwaukee Ave
Ste 103
Chicago, IL 60630
Phone (773) 577-2100

NPI Registry JSON

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

{
    "created_epoch": "1284681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284681600000",
    "number": "1447568977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4849 N. MILWAUKEE AVE",
            "address_2": "SUITE 103",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606302171",
            "telephone_number": "773-577-2100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4849 N. MILWAUKEE AVE",
            "address_2": "SUITE 103",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606302171",
            "telephone_number": "773-577-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PANOS DENTISTRY CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-17",
        "last_updated": "2010-09-17",
        "status": "A",
        "authorized_official_last_name": "PELLETIER",
        "authorized_official_first_name": "SUE",
        "authorized_official_title_or_position": "ADMIN ASSISTANCE",
        "authorized_official_telephone_number": "773-577-2100",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019-020397",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IL",
            "license": "021-000547",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL PROVIDER NUMBER",
            "identifier": "1104979533",
            "state": "IL"
        }
    ],
    "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 Sep 17, 2010; 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.