Midwest Family Dental, LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

MIDWEST FAMILY DENTAL, LLC

Practice address

916 N Green Bay Rd
Waukegan, IL 60085-2240

Phone

(773) 267-8600

Fax

(773) 267-8601

NPI assigned

Sep 16, 2014

Last updated

Sep 16, 2014By 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. Randolph Chang, DDS

Title

Member

Phone

(773) 267-8600

Specialties & licenses 1

Addresses

Tax ID family

Midwest Family Dental LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Midwest Family Dental, LLC

  • General Practice Dentistry
  • Chicago, IL
  • NPI 1497027015
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Randy Chang, D.D.S.

  • General Practice Dentistry
  • Waukegan, IL
  • NPI 1013913342
  NPD (past)

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

{
    "created_epoch": "1410825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410825600000",
    "number": "1508268053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "916 N GREEN BAY RD",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600852240",
            "telephone_number": "773-267-8600",
            "fax_number": "773-267-8601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "916 N GREEN BAY RD",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600852240",
            "telephone_number": "773-267-8600",
            "fax_number": "773-267-8601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST FAMILY DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-16",
        "last_updated": "2014-09-16",
        "status": "A",
        "authorized_official_last_name": "CHANG",
        "authorized_official_first_name": "RANDOLPH",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "773-267-8600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniela Meyer
• Kimberly D Meyer
• MHCS Unincorporated Association
• Midway Emergency Physicians, LLC
• Midway Physician Group
• Midwestern Care Solutions, LLC
• Amanda Mikols
• Mila-Marie Kyncl, MD, SC
• Jose A Millan
• Michelle Millan

• Dentist in Waukegan, IL
• Providers in Waukegan, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2014; 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.