NPIMap

Organization Active NPI

Midway Family Dental, LLC

  • Dentist
  • Chicago, IL
National Provider Identifier
1730747338
Registry record updated May 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
MIDWAY FAMILY DENTAL, LLC
Practice address
6258 S Pulaski Rd
Chicago, IL 60629-4610
Phone
(773) 777-6363
NPI assigned
May 30, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2019

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

Authorized official

Name
Dr. Ghazal S Kermani, DDSNPI 1134697683
Title
Manager/Owner
Phone
(949) 701-5320

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
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

6258 S Pulaski Rd
Chicago, IL 60629-4610

Mailing address

6258 S Pulaski Rd
Chicago, IL 60629-4610
Phone (773) 777-6363

Other names 1

  • 63 Family Dental Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1559174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559174400000",
    "number": "1730747338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6258 S PULASKI RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606294610",
            "telephone_number": "773-777-6363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6258 S PULASKI RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606294610",
            "telephone_number": "773-777-6363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWAY FAMILY DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-30",
        "last_updated": "2019-05-30",
        "status": "A",
        "authorized_official_last_name": "KERMANI",
        "authorized_official_first_name": "GHAZAL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MANAGER/OWNER",
        "authorized_official_telephone_number": "949-701-5320",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "63 Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 May 30, 2019; 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.