Irene Nosrati, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019028774 Issued in IL

Practice address

342 Randall Rd
South Elgin, IL 60177-2261

Phone

(317) 507-9033

NPI assigned

Sep 6, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Irene Berman Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Irene Nosrati, DDS, and Erez Nosrati, DMD, Inc.

  • General Practice Dentistry
  • La Jolla, CA
  • NPI 1659874568
  NPD (past) Authorized official

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

{
    "created_epoch": "1315267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520812800000",
    "number": "1477834307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5175 PEARLMAN WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921303715",
            "telephone_number": "317-507-9033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "342 RANDALL RD",
            "city": "SOUTH ELGIN",
            "state": "IL",
            "postal_code": "601772261",
            "telephone_number": "317-507-9033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOSRATI",
        "first_name": "IRENE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-06",
        "last_updated": "2018-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12011618A",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "65156",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019028774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "IRENE",
            "last_name": "BERMAN",
            "credential": "D.D.S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• General Practice Dentistry in South Elgin, IL
• Providers in South Elgin, 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 Mar 12, 2018; 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.