Crestwood Dental and TMJ Care PC

Primary specialty

DentistTaxonomy code 122300000X

License

019024802 Issued in IL

Legal business name

CRESTWOOD DENTAL AND TMJ CARE PC

Practice address

13549 Cicero Ave
Crestwood, IL 60445-1934

Phone

(708) 388-3200

NPI assigned

Sep 1, 2015

Last updated

Aug 8, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kevin BargamianNPI 1154475630

Title

President

Phone

(708) 388-3200

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kevin Martin Bargamian, DMD

  • Dentist
  • Crestwood, IL
  • NPI 1154475630
  NPD (past) Authorized official

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

{
    "created_epoch": "1441065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470614400000",
    "number": "1730556101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13549 CICERO AVE",
            "city": "CRESTWOOD",
            "state": "IL",
            "postal_code": "604451934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13549 CICERO AVE",
            "city": "CRESTWOOD",
            "state": "IL",
            "postal_code": "604451934",
            "telephone_number": "708-388-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTWOOD DENTAL AND TMJ CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-01",
        "last_updated": "2016-08-08",
        "status": "A",
        "authorized_official_last_name": "BARGAMIAN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-388-3200",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019024802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erica M Coleman, COTA/L
• Cheryl Ann Connelly, MS SLP/CCC
• Crestwood Associated Medical Center LTD
• Crestwood Care Centre LP
• Crestwood Chiropractic and Rehab
• Crestwood Dental Care PC (Family Dental Care)
• Crestwood Medical Associates LTD
• Crestwood Rehabilitation Center LLC
• Crestwood Terrace Operator LLC
• CT Care, LLC (Crestwood Terrace Nursing Center)

• Dentist in Crestwood, IL
• Providers in Crestwood, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 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.