NPIMap

Organization Active NPI

Pearl Dental LLC

  • Dental Clinic/Center
  • Chicago, IL
National Provider Identifier
1558649368
Registry record updated Jul 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
019024870 Issued in IL
Legal business name
PEARL DENTAL LLC
Practice address
4527 N Pulaski Rd
Chicago, IL 60630-4415
Phone
(630) 240-1984
NPI assigned
Jul 27, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2011

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

Authorized official

Name
Fawaz Kannout
Title
DDS
Phone
(630) 240-1984

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 019024870 IL Primary

Addresses

Primary practice location

4527 N Pulaski Rd
Chicago, IL 60630-4415

Mailing address

4527 N Pulaski Rd
Chicago, IL 60630-4415

National Provider Directory

National Provider Directory
Tax ID family
Advanced Dental Makeover2 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.

NPI Registry JSON

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

{
    "created_epoch": "1311724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311724800000",
    "number": "1558649368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4527 N PULASKI RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606304415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4527 N PULASKI RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606304415",
            "telephone_number": "630-240-1984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEARL DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-27",
        "last_updated": "2011-07-27",
        "status": "A",
        "authorized_official_last_name": "KANNOUT",
        "authorized_official_first_name": "FAWAZ",
        "authorized_official_title_or_position": "DDS",
        "authorized_official_telephone_number": "630-240-1984"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": "019024870",
            "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 Jul 27, 2011; 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.