NPIMap

Organization Active NPI

Pearl Dental, LLC

  • General Practice Dentistry
  • Chicago, IL
National Provider Identifier
1821492463
Registry record updated Oct 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019024870 Issued in IL
Legal business name
PEARL DENTAL, LLC
Practice address
4707 N Pulaski Rd Ste 103
Chicago, IL 60630-4312
Phone
(773) 604-5050
Fax
(773) 604-5030
NPI assigned
Oct 10, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2014

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

Authorized official

Name
Mr. Fawaz Kannout, D.D.S
Title
Owner
Phone
(773) 604-5050

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 019024870 IL Primary

Addresses

Primary practice location

4707 N Pulaski Rd Ste 103
Chicago, IL 60630-4312

Mailing address

4707 N Pulaski Rd Ste 103
Chicago, IL 60630-4312
Phone (773) 604-5050

Other names 1

  • advanced dental makeover Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Advanced Dental Makeover2 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.

Locations

4707 N Pulaski Rd
Ste 103
Chicago, IL 60630
Phone (773) 604-5050

NPI Registry JSON

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

{
    "created_epoch": "1412899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412899200000",
    "number": "1821492463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4707 N PULASKI RD STE 103",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606304312",
            "telephone_number": "773-604-5050",
            "fax_number": "773-604-5030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4707 N PULASKI RD STE 103",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606304312",
            "telephone_number": "773-604-5050",
            "fax_number": "773-604-5030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEARL DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-10",
        "last_updated": "2014-10-10",
        "status": "A",
        "authorized_official_last_name": "KANNOUT",
        "authorized_official_first_name": "FAWAZ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-604-5050",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019024870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "advanced dental makeover",
            "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 Oct 10, 2014; 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.