Chicagoland Dental Associates PC

Primary specialty

DentistTaxonomy code 122300000X

License

019023492 Issued in IL

Legal business name

CHICAGOLAND DENTAL ASSOCIATES PC

Doing business as

Bucktown Dental Associates

Practice address

2002 N Damen Ave
Chicago, IL 60647-4527

Phone

(773) 276-2757

Fax

(773) 276-2758

NPI assigned

Jun 25, 2009

Organization subpart

No

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

Authorized official

Name

Yasser Elseweifi, DDSNPI 1245429133

Title

President

Phone

(630) 464-1474

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Bucktown Dental Associates Doing business as

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Yasser Ahmed Elseweifi, DDS

  • Dentist
  • Chicago, IL
  • NPI 1245429133
  NPD (past) Authorized official
• Tarek Elseweifi, DMD

  • Dentist
  • Indianapolis, IN
  • NPI 1558865501
  NPD (past)

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

{
    "created_epoch": "1245888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380585600000",
    "number": "1568690790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2002 N DAMEN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606474527",
            "telephone_number": "773-276-2757",
            "fax_number": "773-276-2758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2002 N DAMEN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606474527",
            "telephone_number": "773-276-2757",
            "fax_number": "773-276-2758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICAGOLAND DENTAL ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-25",
        "last_updated": "2013-10-01",
        "status": "A",
        "authorized_official_last_name": "ELSEWEIFI",
        "authorized_official_first_name": "YASSER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-464-1474",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019023492",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1245429133",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bucktown Dental Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dentist in Chicago, IL
• Providers in Chicago, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2013; 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.