Chicago Avenue Dental Group LTD.

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

019016644 Issued in IL

Legal business name

CHICAGO AVENUE DENTAL GROUP LTD.

Practice address

1802 W Chicago Ave
Chicago, IL 60622-5512

Phone

(773) 276-0633

Fax

(773) 276-0687

NPI assigned

Dec 2, 2008

Organization subpart

No

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

Authorized official

Name

Lee Stansbury, D.D.S.

Title

President

Phone

(773) 276-0633

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1228176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228176000000",
    "number": "1578708707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1802 W CHICAGO AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606225512",
            "telephone_number": "773-276-0633",
            "fax_number": "773-276-0687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1802 W CHICAGO AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606225512",
            "telephone_number": "773-276-0633",
            "fax_number": "773-276-0687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICAGO AVENUE DENTAL GROUP LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-02",
        "last_updated": "2008-12-02",
        "status": "A",
        "authorized_official_last_name": "STANSBURY",
        "authorized_official_first_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-276-0633",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": "019016644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Dental Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2008; 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.