NPIMap

Organization Active NPI

Skyline Smiles of Roscoe Village LLC

  • General Practice Dentistry
  • Chicago, IL
National Provider Identifier
1720433915
Registry record updated Apr 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019027964 Issued in IL
Legal business name
SKYLINE SMILES OF ROSCOE VILLAGE LLC
Practice address
2125 W Roscoe St
Unit a
Chicago, IL 60618-6219
Phone
(312) 759-1120
Fax
(312) 624-9217
NPI assigned
Apr 26, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2016

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

Authorized official

Name
Dr. Deepak Neduvelil, DDS
Title
Owner
Phone
(312) 759-1120

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 019027964 IL Primary

Addresses

Primary practice location

2125 W Roscoe St
Unit a
Chicago, IL 60618-6219

Mailing address

2125 W Roscoe St
Unit a
Chicago, IL 60618-6219
Phone (312) 759-1120

National Provider Directory

National Provider Directory

Locations

2125 W Roscoe St
Unit A
Chicago, IL 60618
Phone (312) 759-1120

NPI Registry JSON

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

{
    "created_epoch": "1461628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461628800000",
    "number": "1720433915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2125 W ROSCOE ST",
            "address_2": "UNIT A",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606186219",
            "telephone_number": "312-759-1120",
            "fax_number": "312-624-9217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2125 W ROSCOE ST",
            "address_2": "UNIT A",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606186219",
            "telephone_number": "312-759-1120",
            "fax_number": "312-624-9217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKYLINE SMILES OF ROSCOE VILLAGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-26",
        "last_updated": "2016-04-26",
        "status": "A",
        "authorized_official_last_name": "NEDUVELIL",
        "authorized_official_first_name": "DEEPAK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-759-1120",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019027964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Apr 26, 2016; 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.