Advance Dental Makeover PC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

ADVANCE DENTAL MAKEOVER PC

Practice address

4707 N Pulaski Rd
Chicago, IL 60630-4312

Phone

(773) 604-5050

Fax

(773) 604-5030

NPI assigned

Jul 19, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Wisam R Mohammad, DDS

Title

President

Phone

(773) 604-5050

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Hala Elkhadra, D.D.S

  • Dentist
  • Chicago, IL
  • NPI 1457769259
  NPD (past)

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609895754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4707 N PULASKI RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606304312",
            "telephone_number": "773-604-5050",
            "fax_number": "773-604-5030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4707 N PULASKI RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606304312",
            "telephone_number": "773-604-5050",
            "fax_number": "773-604-5030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCE DENTAL MAKEOVER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOHAMMAD",
        "authorized_official_first_name": "WISAM",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-604-5050",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adithi Sree Adusumilli
• Chowdary Adusumilli, M.D.
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• Advance Lab Company
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• Advance Potential Psychological Services, LLC

• 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 22, 2020; 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.