NPIMap

Individual provider Active NPI

Daniel Michal Domagala, D.D.S., M.S.

  • Dentist
  • Chicago, IL
National Provider Identifier
1497993026
Registry record updated Sep 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019.027866 Issued in IL
Practice address
3208 N. Major Avenue
Chicago, IL 60634
Phone
(773) 777-1111
Fax
(773) 777-0730
NPI assigned
Feb 4, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2010

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthodontics 1223P0700X 019027866 IL
Dentist 122300000X 019.027866 IL Primary
Dentist 122300000X 6468115 WI

Addresses

Primary practice location

3208 N. Major Avenue
Chicago, IL 60634

Mailing address

3208 N. Major Avenue
Chicago, IL 60634
Phone (773) 777-1111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.
Opted out of Medicare
Yes, effective Oct 9, 2014 through Oct 9, 2026

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
019.027866ILMDDentist
6468115WIMDDentist
019027866ILMDProsthodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Quantum Anesthesia Services LLC Past Accepting new patients
Major Dental PC Past Accepting new patients
Mila Zelenkovich, D.D.S.,LTD. Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1233705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1284336000000",
    "number": "1497993026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3208 N. MAJOR AVENUE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60634",
            "telephone_number": "773-777-1111",
            "fax_number": "773-777-0730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3208 N. MAJOR AVENUE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60634",
            "telephone_number": "773-777-1111",
            "fax_number": "773-777-0730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMAGALA",
        "first_name": "DANIEL",
        "middle_name": "MICHAL",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-02-04",
        "last_updated": "2010-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "IL",
            "license": "019027866",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.027866",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "6468115",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.