Maywood Family Dental, LTD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019020091 Issued in IL

Legal business name

MAYWOOD FAMILY DENTAL, LTD

Practice address

1409 S 5TH Ave
Maywood, IL 60153-2128

Phone

(708) 865-2225

NPI assigned

Jun 4, 2014

Organization subpart

No

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

Authorized official

Name

James Poulos

Title

President

Phone

(708) 865-2225

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1401840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413158400000",
    "number": "1518370832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1409 S 5TH AVE",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601532128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 S 5TH AVE",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601532128",
            "telephone_number": "708-865-2225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAYWOOD FAMILY DENTAL, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-04",
        "last_updated": "2014-10-13",
        "status": "A",
        "authorized_official_last_name": "POULOS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-865-2225"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019020091",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracey Hydrick May
• Natasha Romila Mayer
• Ryan Franklin Mayhew, MD
• Maywood Community Pharmacy LLC
• Maywood Dental Excellence
• Maywood Melrose Broadview 89
• Maywood Pharmacy Inc
• Maywood SLF I LP
• Alaleh Mazhari, D.O.
• MB Care Medical Supply Inc

• General Practice Dentistry in Maywood, IL
• Providers in Maywood, 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 Oct 13, 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.