NPIMap

Organization Active NPI

Family Dental Clinic, PC

  • Health Maintenance Organization
  • Chicago, IL
National Provider Identifier
1780848945
Registry record updated Jul 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Maintenance OrganizationTaxonomy code 302R00000X
License
01901529 Issued in IL
Legal business name
FAMILY DENTAL CLINIC, PC
Practice address
3211 W Lawrence Ave
Chicago, IL 60625-5208
Phone
(773) 463-1904
Fax
(773) 463-1257
NPI assigned
Jul 16, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2008

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

Authorized official

Name
Dr. Mohammad ZaffarkhanNPI 1417013061
Title
Dentist
Phone
(773) 463-1904

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
Health Maintenance Organization 302R00000X 01901529 IL Primary

Addresses

Primary practice location

3211 W Lawrence Ave
Chicago, IL 60625-5208

Mailing address

3211 W Lawrence Ave
Chicago, IL 60625-5208
Phone (773) 463-1904

Other identifiers 1

IdentifierTypeStateIssuer
14177013061MedicaidIL

National Provider Directory

National Provider Directory

Locations

3211 W Lawrence Ave
Chicago, IL 60625
Phone (773) 463-1904

Practitioners & affiliated clinicians

Practitioners 1

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": "1216166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216166400000",
    "number": "1780848945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3211 W LAWRENCE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606255208",
            "telephone_number": "773-463-1904",
            "fax_number": "773-463-1257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3211 W LAWRENCE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606255208",
            "telephone_number": "773-463-1904",
            "fax_number": "773-463-1257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY DENTAL CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-16",
        "last_updated": "2008-07-16",
        "status": "A",
        "authorized_official_last_name": "ZAFFARKHAN",
        "authorized_official_first_name": "MOHAMMAD",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "773-463-1904",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "IL",
            "license": "01901529",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14177013061",
            "state": "IL"
        }
    ],
    "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 Jul 16, 2008; 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.