NPIMap

Organization Active NPI

Family Dental Group, Inc.

  • General Practice Dentistry
  • Chicago, IL
National Provider Identifier
1538330758
Registry record updated Jan 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
FAMILY DENTAL GROUP, INC.
Practice address
3855 W North Ave
Chicago, IL 60647-4640
Phone
(773) 782-8900
Fax
(773) 782-0577
NPI assigned
Mar 15, 2008
Last updated
Jan 7, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2026

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

Authorized official

Name
Ivana Bueno
Title
Director
Phone
(773) 798-9382

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

3855 W North Ave
Chicago, IL 60647-4640

Mailing address

3855 W North Ave
Chicago, IL 60647-4640
Phone (773) 782-8900

Other identifiers 1

IdentifierTypeStateIssuer
103156MedicaidIL

National Provider Directory

National Provider Directory

Locations

3855 W North Ave
Chicago, IL 60647
Phone (773) 782-8900

Practitioners & affiliated clinicians

Practitioners 5

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": "1205539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767744000000",
    "number": "1538330758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3855 W NORTH AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606474640",
            "telephone_number": "773-782-8900",
            "fax_number": "773-782-0577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3855 W NORTH AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606474640",
            "telephone_number": "773-782-8900",
            "fax_number": "773-782-0577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY DENTAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-15",
        "last_updated": "2026-01-07",
        "certification_date": "2026-01-07",
        "status": "A",
        "authorized_official_last_name": "BUENO",
        "authorized_official_first_name": "IVANA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "773-798-9382"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103156",
            "state": "IL"
        }
    ],
    "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 Jan 7, 2026; 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.