Hermosa Dental Clinic

Primary specialty

DentistTaxonomy code 122300000X

License

1915779 Issued in IL

Legal business name

HERMOSA DENTAL CLINIC

Doing business as

Dr Sabah H Khalifa DDS PC

Practice address

2004 N Pulaski Rd
Chicago, IL 60639

Phone

(773) 342-5923

Fax

(773) 342-0835

NPI assigned

Nov 2, 2005

Organization subpart

No

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

Authorized official

Name

Sabah H Khalifa, DDS

Title

Owner

Phone

(773) 342-5923

Specialties & licenses 1

Addresses

Other names 1

• Dr Sabah H Khalifa DDS PC Doing business as

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801887583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2004 N PULASKI RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60639",
            "telephone_number": "773-342-5923",
            "fax_number": "773-342-0835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2004 N PULASKI RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60639",
            "telephone_number": "773-342-5923",
            "fax_number": "773-342-0835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERMOSA DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KHALIFA",
        "authorized_official_first_name": "SABAH",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-342-5923",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "1915779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr Sabah H Khalifa DDS PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Andrew M Hermina, MD
• Nicholas Hermina
• Rita Hermiz, PHARMD
• Taylor Anne Hermle
• Brazil Hermon
• Hermosa Healthcare of Chicago Inc.
• Hermosa Medical & Diagnostic Center Inc
• Hermosa Pharmacy Inc
• Cynthia Chicago Hermosillo
• Rachel Anne Hern, OTD, OTR/L

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.