NPIMap

Organization Active NPI

Petrie Storer & Associates DDS PC

  • General Practice Dentistry
  • Chicago, IL
National Provider Identifier
1730273558
Registry record updated Aug 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
060006717 Issued in IL
Legal business name
PETRIE STORER & ASSOCIATES DDS PC
Practice address
7447 W Talcott Ave
Suite 560
Chicago, IL 60631-3745
Phone
(773) 763-5353
Fax
(773) 763-3565
NPI assigned
Oct 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2015

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

Authorized official

Name
Dr. Mark M Storer, DDSNPI 1649377623
Title
Owner
Phone
(773) 763-5353

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 060006717 IL Primary

Addresses

Primary practice location

7447 W Talcott Ave
Suite 560
Chicago, IL 60631-3745

Mailing address

7447 W Talcott Ave
Suite 560
Chicago, IL 60631-3745
Phone (773) 763-5353

National Provider Directory

National Provider Directory

Locations

7447 W Talcott Ave
Ste 560
Chicago, IL 60631
Phone (773) 763-5353

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439769600000",
    "number": "1730273558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7447 W TALCOTT AVE",
            "address_2": "SUITE 560",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606313745",
            "telephone_number": "773-763-5353",
            "fax_number": "773-763-3565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7447 W TALCOTT AVE",
            "address_2": "SUITE 560",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606313745",
            "telephone_number": "773-763-5353",
            "fax_number": "773-763-3565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETRIE STORER & ASSOCIATES DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2015-08-17",
        "status": "A",
        "authorized_official_last_name": "STORER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-763-5353",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "060006717",
            "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 Aug 17, 2015; 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.