NPIMap

Organization Active NPI

Dentistar PC

  • Dentist
  • Glenview, IL
National Provider Identifier
1598203770
Registry record updated Feb 7, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019027805 Issued in IL
Legal business name
DENTISTAR PC
Practice address
1615 Milwaukee Ave Ste 120
Glenview, IL 60025-1444
Phone
(224) 938-9417
Fax
(224) 938-9453
NPI assigned
Feb 7, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2017

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

Authorized official

Name
Dr. Sam Shin, DDS
Title
Dentist
Phone
(224) 938-9417

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 019027805 IL Primary

Addresses

Primary practice location

1615 Milwaukee Ave Ste 120
Glenview, IL 60025-1444

Mailing address

1615 Milwaukee Ave Ste 120
Glenview, IL 60025-1444
Phone (224) 938-9417

National Provider Directory

National Provider Directory

Locations

1615 Milwaukee Ave
Ste 120
Glenview, IL 60025
Phone (224) 938-9417

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1486425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486425600000",
    "number": "1598203770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 MILWAUKEE AVE STE 120",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600251444",
            "telephone_number": "224-938-9417",
            "fax_number": "224-938-9453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 MILWAUKEE AVE STE 120",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600251444",
            "telephone_number": "224-938-9417",
            "fax_number": "224-938-9453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTISTAR PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-07",
        "last_updated": "2017-02-07",
        "status": "A",
        "authorized_official_last_name": "SHIN",
        "authorized_official_first_name": "SAM",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "224-938-9417",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019027805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glenview, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2017; 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.