NPIMap

Organization Active NPI

Bridgeport Smiles

  • General Practice Dentistry
  • Chicago, IL
National Provider Identifier
1528487220
Registry record updated Sep 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019026249 Issued in IL
Legal business name
BRIDGEPORT SMILES
Practice address
3014 S Halsted St
Chicago, IL 60608-5805
Phone
(312) 291-9283
NPI assigned
Apr 9, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2014

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

Authorized official

Name
Dr. Neepa Modi, DDS
Title
Owner
Phone
(312) 291-9283

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 019026249 IL Primary

Addresses

Primary practice location

3014 S Halsted St
Chicago, IL 60608-5805

Mailing address

3014 S Halsted St
Chicago, IL 60608-5805
Phone (312) 291-9283

National Provider Directory

National Provider Directory

Locations

3014 S Halsted St
Chicago, IL 60608
Phone (219) 465-8627

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1397001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409616000000",
    "number": "1528487220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3014 S HALSTED ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606085805",
            "telephone_number": "312-291-9283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3014 S HALSTED ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606085805",
            "telephone_number": "312-291-9283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGEPORT SMILES",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-09",
        "last_updated": "2014-09-02",
        "status": "A",
        "authorized_official_last_name": "MODI",
        "authorized_official_first_name": "NEEPA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-291-9283",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019026249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Sep 2, 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.