Sura Ghazi, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019.032251 Issued in IL

Practice address

1 Chicago Ave
Oak Park, IL 60302-2432

Phone

(708) 948-7744

NPI assigned

Jul 26, 2019

Last updated

Jul 26, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pro Dental Il - Chad Wise PC

  dba Destiny Dental of Oak Park

  • Dentist
  • Oak Park, IL
  • NPI 1710714233

  General Practice

  NPD
• D2 Dental of Lansing, P.C.

  • General Practice Dentistry
  • Oak Park, IL
  • NPI 1891259768
  NPD (past)

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

{
    "created_epoch": "1564099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564099200000",
    "number": "1619521762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CHICAGO AVE",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603022432",
            "telephone_number": "708-948-7744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CHICAGO AVE",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603022432",
            "telephone_number": "708-948-7744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHAZI",
        "first_name": "SURA",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-26",
        "last_updated": "2019-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.032251",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madeline J Gerig Shelly
• Nicole H Gerndt, LCPC
• Tara Diederich Gerou, D.C.
• Gesl Medical Imaging MD SC LTD
• Rad Gharavi, M.D.
• Farid Gholitabar, M.D.
• Samantha Gianakas, MS, RD, LDN
• Kathleen Anna Tressel Giandonato, MS, MSW, LCSW
• Joan M. Gibbons, OT
• Benedict Gierl, M.D.

• General Practice Dentistry in Oak Park, IL
• Providers in Oak Park, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.