Pardesi Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019.030152 Issued in IL

Legal business name

PARDESI DENTAL LLC

Doing business as

Old Town Dental Associates

Practice address

526 Dixie Hwy
Beecher, IL 60401-3698

Phone

(708) 946-9494

NPI assigned

Sep 26, 2016

Organization subpart

No

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

Authorized official

Name

Mr. Zaid Pardesi

Title

Managing Director

Phone

(847) 312-8721

Specialties & licenses 1

Addresses

Other names 1

• Old Town Dental Associates Doing business as

Tax ID family

Hub Family Dental2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Hub Family Dental

  • Dentist
  • Rochelle, IL
  • NPI 1871942730
  NPD tax ID

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

{
    "created_epoch": "1474848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474848000000",
    "number": "1740739135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 S MICHIGAN AVE",
            "address_2": "APT 2505",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606052548",
            "telephone_number": "847-312-8721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "526 DIXIE HWY",
            "city": "BEECHER",
            "state": "IL",
            "postal_code": "604013698",
            "telephone_number": "708-946-9494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARDESI DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-26",
        "last_updated": "2016-09-26",
        "status": "A",
        "authorized_official_last_name": "PARDESI",
        "authorized_official_first_name": "ZAID",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "847-312-8721",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.030152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Old Town Dental Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Beecher, IL
• Providers in Beecher, IL by specialty
• General Practice Dentistry in Illinois

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