Logan Square Dental Service Center

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

LOGAN SQUARE DENTAL SERVICE CENTER

Doing business as

Cicero Irving Park Dental Group

Practice address

3946 N Cicero Ave
Chicago, IL 60641-2711

Phone

(773) 283-4838

Fax

(773) 283-4389

NPI assigned

Mar 25, 2008

Organization subpart

No

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

Authorized official

Name

Dr. William Li, D.D.S.

Title

President

Phone

(847) 284-0410

Specialties & licenses 1

Addresses

Other names 1

• Cicero Irving Park Dental Group Doing business as

Locations

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

{
    "created_epoch": "1206403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206403200000",
    "number": "1508038027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3946 N CICERO AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606412711",
            "telephone_number": "773-283-4838",
            "fax_number": "773-283-4389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3946 N CICERO AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606412711",
            "telephone_number": "773-283-4838",
            "fax_number": "773-283-4389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOGAN SQUARE DENTAL SERVICE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-25",
        "last_updated": "2008-03-25",
        "status": "A",
        "authorized_official_last_name": "LI",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-284-0410",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cicero Irving Park Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Logan Authorization
• Logan General Medical Center Inc
• Logan Square Acupuncture, LLC
• Logan Square Anesthesia PC
• Logan Square Counseling LLC
• Logan Square Foot Center
• Logan Square Foot Center PC
• Logan Square Medical Institute SC
• Logan Square MRI
• Logan Square Supportive Living LLC

• Dental Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Dental Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2008; 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.