My Family Dental Care, P.C.

Primary specialty

DentistTaxonomy code 122300000X

License

019018019 Issued in IL

Legal business name

MY FAMILY DENTAL CARE, P.C.

Practice address

6223 Dempster St
Morton Grove, IL 60053-2818

Phone

(224) 534-7123

Fax

(224) 534-7214

NPI assigned

Nov 14, 2011

Organization subpart

No

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

Authorized official

Name

Sandy Certeza

Title

Practice Manager

Phone

(630) 456-3832

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1321228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321228800000",
    "number": "1831476183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6223 DEMPSTER ST",
            "city": "MORTON GROVE",
            "state": "IL",
            "postal_code": "600532818",
            "telephone_number": "224-534-7123",
            "fax_number": "224-534-7214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6223 DEMPSTER ST",
            "city": "MORTON GROVE",
            "state": "IL",
            "postal_code": "600532818",
            "telephone_number": "224-534-7123",
            "fax_number": "224-534-7214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY FAMILY DENTAL CARE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-14",
        "last_updated": "2011-11-14",
        "status": "A",
        "authorized_official_last_name": "CERTEZA",
        "authorized_official_first_name": "SANDY",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "630-456-3832"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019018019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 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.