Active NPI
Mohamad Alhadlaq, BDS
- Pediatric Dentistry
- Chicago, IL
National Provider Identifier
1831679844
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 018.002084
- Practice address
- 801 S Paulina St # Mc850
Chicago, IL 60612-7210 - Phone
- (312) 413-7714
- NPI assigned
- Aug 19, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 018.002084 | IL | Primary |
Addresses
Primary practice location
801 S Paulina St # Mc850
Chicago, IL 60612-7210
Mailing address
801 S Paulina St # Mc850
Chicago, IL 60612-7210
Phone (312) 413-7714
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190925002460 | IL | Order and Referring Only - Dentist | 9638409170 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 018.002084 | IL | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534636800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534636800000",
"number": "1831679844",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "801 S PAULINA ST # MC850",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606127210",
"telephone_number": "312-413-7714"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 S PAULINA ST # MC850",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606127210",
"telephone_number": "312-413-7714"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALHADLAQ",
"first_name": "MOHAMAD",
"name_prefix": "Dr.",
"credential": "BDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-08-19",
"last_updated": "2018-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "IL",
"license": "018.002084",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Aug 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.