NPIMap

Organization Active NPI

Smile360Chicago

  • Dental Clinic/Center
  • Chicago, IL
National Provider Identifier
1487280202
Registry record updated Mar 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
SMILE360CHICAGO
Practice address
2836 W Devon Ave
Chicago, IL 60659-1513
Phone
(773) 338-7565
NPI assigned
Mar 13, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2020

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

Authorized official

Name
Dr. Mustafa Salam, DMDNPI 1477108959
Title
Dentist/Owner
Phone
(773) 338-7565

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

2836 W Devon Ave
Chicago, IL 60659-1513

Mailing address

2836 W Devon Ave
Chicago, IL 60659-1513
Phone (773) 338-7565

Other names 1

  • smile360chicago Doing business as

National Provider Directory

National Provider Directory

Locations

2836 W Devon Ave
Chicago, IL 60659
Phone (773) 338-7565

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1584057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584057600000",
    "number": "1487280202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2836 W DEVON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606591513",
            "telephone_number": "773-338-7565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2836 W DEVON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606591513",
            "telephone_number": "773-338-7565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMILE360CHICAGO",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-13",
        "last_updated": "2020-03-13",
        "certification_date": "2020-03-13",
        "status": "A",
        "authorized_official_last_name": "SALAM",
        "authorized_official_first_name": "MUSTAFA",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "773-338-7565",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "smile360chicago",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Mar 13, 2020; 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.