Dexter Dental 2 LLC

Primary specialty

DentistTaxonomy code 122300000X

License

019026920 Issued in IL

Legal business name

DEXTER DENTAL 2 LLC

Practice address

47 Clock Tower PLZ
Elgin, IL 60120-7800

Phone

(888) 988-4066

Fax

(847) 496-7202

NPI assigned

Sep 26, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Koushan H Azad, DMD

Title

President

Phone

(888) 988-4066

Specialties & licenses 1

Addresses

Other names 1

• FAMILIA DENTAL Doing business as

Locations

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

{
    "created_epoch": "1316995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316995200000",
    "number": "1780967828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 E ALGONQUIN RD",
            "address_2": "SUITE 610",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601734144",
            "telephone_number": "888-988-4066",
            "fax_number": "847-496-7202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47 CLOCK TOWER PLZ",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601207800",
            "telephone_number": "888-988-4066",
            "fax_number": "847-496-7202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEXTER DENTAL 2 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-26",
        "last_updated": "2011-09-26",
        "status": "A",
        "authorized_official_last_name": "H AZAD",
        "authorized_official_first_name": "KOUSHAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "888-988-4066",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019026920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAMILIA DENTAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ruben P Dettman, CRNA
• Tammy A Devries
• Christina Grace Dewar, BSW
• Tracey Dewis, BCBA
• Megan Dewitt
• Dexter Dental 3 LLC
• Dexter Dental LLC
• Supreet Kaur Dhaliwal
• Anik Dharia, PHARMD
• Sunita Dhawan

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2011; 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.