Primecare Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019019366 Issued in IL

Legal business name

PRIMECARE DENTAL LLC

Practice address

4239 W North Ave
Chicago, IL 60639-4852

Phone

(773) 276-3360

Fax

(773) 276-4032

NPI assigned

Nov 6, 2009

Last updated

Nov 6, 2009By 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

Dr. Kathleen M Hansen, D.D.S.

Title

Sole Member

Phone

(773) 276-3360

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1257465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257465600000",
    "number": "1467789867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4239 W NORTH AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606394852",
            "telephone_number": "773-276-3360",
            "fax_number": "773-276-4032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4239 W NORTH AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606394852",
            "telephone_number": "773-276-3360",
            "fax_number": "773-276-4032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMECARE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-06",
        "last_updated": "2009-11-06",
        "status": "A",
        "authorized_official_last_name": "HANSEN",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "773-276-3360",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019019366",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Primecare Community Health, Inc. (PrimeCare Hamlin)
• Primecare Community Health, Inc.
• Primecare Community Health, Inc.
• Primecare Community Health, Inc. (PrimeCare Northwest)
• Primecare Community Health, Inc. (PrimeCare Fullerton)
• Primecare Diagnostics Imaging Group, Inc.
• Primecare Diagnostics Inc
• Primecare Diagnostics LLC
• Primecare Family Physicians, LTD
• Primecare Home Health Inc.

• 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 Nov 6, 2009; 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.