Individual provider Active NPI

Susan Becker Doroshow, D.D.S.

  • General Practice Dentistry
  • Skokie, IL
National Provider Identifier
1689798167
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Practice address
3901 Howard St
Skokie, IL 60076-3778
Phone
(847) 677-2774
Fax
(847) 677-1138
NPI assigned
Mar 19, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X IL Primary

Addresses

Primary practice location

3901 Howard St
Skokie, IL 60076-3778

Mailing address

3901 Howard St
Skokie, IL 60076-3778
Phone (847) 677-2774

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20150520002517 IL Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 4688994304

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019-018739ILMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689798167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 HOWARD ST",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600763778",
            "telephone_number": "847-677-2774",
            "fax_number": "847-677-1138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 HOWARD ST",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600763778",
            "telephone_number": "847-677-2774",
            "fax_number": "847-677-1138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOROSHOW",
        "first_name": "SUSAN",
        "middle_name": "BECKER",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Skokie, IL

Sources for this page

Verify at the official NPI Registry.