NPIMap

Organization Active NPI

Pristine Family Dental

  • General Practice Dentistry
  • Romeoville, IL
National Provider Identifier
1558659169
Registry record updated Jul 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019026952 Issued in IL
Legal business name
PRISTINE FAMILY DENTAL
Practice address
384 S Weber Rd
Romeoville, IL 60446-6521
Phone
(815) 609-1600
NPI assigned
Jul 17, 2011
Last updated
Jul 17, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2011

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

Authorized official

Name
Anjum Zaheer Khan, DDSNPI 1437232048
Title
President
Phone
(773) 816-2595

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 019026952 IL Primary

Addresses

Primary practice location

384 S Weber Rd
Romeoville, IL 60446-6521

Mailing address

384 S Weber Rd
Romeoville, IL 60446-6521
Phone (815) 609-1600

National Provider Directory

National Provider Directory

Locations

384 S Weber Rd
Romeoville, IL 60446
Phone (815) 609-1600

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1310860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310860800000",
    "number": "1558659169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "384 S WEBER RD",
            "city": "ROMEOVILLE",
            "state": "IL",
            "postal_code": "604466521",
            "telephone_number": "815-609-1600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "384 S WEBER RD",
            "city": "ROMEOVILLE",
            "state": "IL",
            "postal_code": "604466521",
            "telephone_number": "815-609-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRISTINE FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-17",
        "last_updated": "2011-07-17",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "ANJUM",
        "authorized_official_middle_name": "ZAHEER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-816-2595",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019026952",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Romeoville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 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.