Family Dental Practice

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

019024490 Issued in IL

Legal business name

FAMILY DENTAL PRACTICE

Practice address

9709 Milwaukee Ave
Glenview, IL 60025-4567

Phone

(847) 581-1418

NPI assigned

Oct 21, 2016

Organization subpart

No

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

Authorized official

Name

Susan Edukutharayil

Title

General Dentist

Phone

(847) 581-1418

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1477008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477008000000",
    "number": "1821549163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9709 MILWAUKEE AVE",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600254567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9709 MILWAUKEE AVE",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600254567",
            "telephone_number": "847-581-1418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY DENTAL PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-21",
        "last_updated": "2016-10-21",
        "status": "A",
        "authorized_official_last_name": "EDUKUTHARAYIL",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "GENERAL DENTIST",
        "authorized_official_telephone_number": "847-581-1418"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "IL",
            "license": "019024490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Fager
• Sara Marie Fait, PT
• Emily Jeanne Kissell Falvey
• Family and Child Roots & Wings, PLLC
• Family Dental Center
• Family Guidance Centers, Inc.
• Jonathan Hwa Fang, M.D.
• Spencer Fang, PT, DPT
• Leanne Farley, P.T.
• Rabiya Farooqui

• Preferred Provider Organization in Glenview, IL
• Providers in Glenview, IL by specialty
• Preferred Provider Organization in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 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.