NPIMap

Organization Active NPI

Wicker Park Orthodontia, LTD.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Chicago, IL
National Provider Identifier
1609016351
Registry record updated Feb 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
060010055 Issued in IL
Legal business name
WICKER PARK ORTHODONTIA, LTD.
Practice address
1921 W. North Ave S
Chicago, IL 60622
Phone
(773) 276-5566
NPI assigned
Feb 20, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2009

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

Authorized official

Name
Nidza Alicea
Title
Manager
Phone
(773) 235-0980

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0400X 060010055 IL Primary

Addresses

Primary practice location

1921 W. North Ave S
Chicago, IL 60622

Mailing address

1921 W. North Ave S
Chicago, IL 60622
Phone (773) 276-0335

Other names 1

  • Wicker Park Orthodontics Doing business as

National Provider Directory

National Provider Directory

Locations

1921 W North Ave
Chicago, IL 60622
Phone (773) 276-0335

Practitioners & affiliated clinicians

Practitioners 2

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": "1235088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235088000000",
    "number": "1609016351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1921 W. NORTH AVE S",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60622",
            "telephone_number": "773-276-0335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1921 W. NORTH AVE S",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60622",
            "telephone_number": "773-276-5566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WICKER PARK ORTHODONTIA, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-20",
        "last_updated": "2009-02-20",
        "status": "A",
        "authorized_official_last_name": "ALICEA",
        "authorized_official_first_name": "NIDZA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "773-235-0980"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IL",
            "license": "060010055",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wicker Park Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2009; 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.