Woodlawn Dental Gallery

Primary specialty

DentistTaxonomy code 122300000X

License

019027749 Issued in IL

Legal business name

WOODLAWN DENTAL GALLERY

Practice address

1502 E 63Rd St
Chicago, IL 60637-2921

Phone

(773) 496-5138

Fax

(773) 496-5142

NPI assigned

Aug 19, 2015

Last updated

Aug 19, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Ogbonna Bankole Bowden, DDSNPI 1467687921

Title

President

Phone

(773) 793-1220

Specialties & licenses 1

Addresses

Locations

Practitioners 3

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.

• Ogbonna B Bowden, D.D.S

  • Dentist
  • Chicago, IL
  • NPI 1467687921
  NPD (past) Authorized official
• Adeniji Bowden, DDS

  • General Practice Dentistry
  • Evanston, IL
  • NPI 1023596228
  NPD (past)
• Asia Smith-Vernon, RDH

  • Dentist
  • Peoria, IL
  • NPI 1053783571
  NPD (past)

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

{
    "created_epoch": "1439942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439942400000",
    "number": "1568838043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8544 S STONY ISLAND AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606172248",
            "telephone_number": "773-221-0800",
            "fax_number": "773-221-0868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 E 63RD ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606372921",
            "telephone_number": "773-496-5138",
            "fax_number": "773-496-5142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODLAWN DENTAL GALLERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-19",
        "last_updated": "2015-08-19",
        "status": "A",
        "authorized_official_last_name": "BOWDEN",
        "authorized_official_first_name": "OGBONNA",
        "authorized_official_middle_name": "BANKOLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-793-1220",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019027749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Woodfern Psychotherapy LLC
• Denton Woodfern
• Ariel Woodfork
• Woodlake Technologies Inc
• Woodlawn Chicago CVS LLC (CVS Pharmacy)
• Audrey Woodley
• Elizabeth Woodley, PA-C
• Gabrielle Woodman, PA-C
• Jessica Woodrich
• Robert Steven Woodrick, MD

• 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 Aug 19, 2015; 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.