Active NPI
Bara M Abusharara, DMD
- Dentist
- Burbank, IL
National Provider Identifier
1689166456
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019031659
- Practice address
- 5501 W 79TH St Ste 201
Burbank, IL 60459-1796 - Phone
- (708) 424-5901
- NPI assigned
- Jun 6, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019031659 | IL | Primary |
Addresses
Primary practice location
5501 W 79TH St Ste 201
Burbank, IL 60459-1796
Mailing address
5241 W 108TH PL
Oak Lawn, IL 60453-5087
Phone (708) 601-3822
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019031659 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central Amazing Dental LLC | Dentist | Past | Accepting new patients |
| Dental Prestige LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Burbank, IL
- NPI 1487826129
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528243200000",
"number": "1689166456",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5241 W 108TH PL",
"city": "OAK LAWN",
"state": "IL",
"postal_code": "604535087",
"telephone_number": "708-601-3822"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5501 W 79TH ST STE 201",
"city": "BURBANK",
"state": "IL",
"postal_code": "604591796",
"telephone_number": "708-424-5901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ABUSHARARA",
"first_name": "BARA",
"middle_name": "M",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-06-06",
"last_updated": "2018-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019031659",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burbank, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.