NPIMap

Organization Active NPI

Dental Image

  • General Practice Dentistry
  • Chicago, IL
National Provider Identifier
1841464989
Registry record updated Apr 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
DENTAL IMAGE
Practice address
4724 N Kedzie Ave
Chicago, IL 60625-4421
Phone
(773) 583-4455
Fax
(773) 583-8986
NPI assigned
Apr 19, 2008
Last updated
Apr 19, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2008

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

Authorized official

Name
Mrs. Terri Cruz
Title
Office Manager
Phone
(773) 583-4455

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X IL Primary

Addresses

Primary practice location

4724 N Kedzie Ave
Chicago, IL 60625-4421

Mailing address

4724 N Kedzie Ave
Chicago, IL 60625-4421
Phone (773) 583-4455

National Provider Directory

National Provider Directory

Locations

4724 N Kedzie Ave
Chicago, IL 60625
Phone (773) 583-4455

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1208563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208563200000",
    "number": "1841464989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4724 N KEDZIE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606254421",
            "telephone_number": "773-583-4455",
            "fax_number": "773-583-8986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4724 N KEDZIE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606254421",
            "telephone_number": "773-583-4455",
            "fax_number": "773-583-8986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL IMAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-19",
        "last_updated": "2008-04-19",
        "status": "A",
        "authorized_official_last_name": "CRUZ",
        "authorized_official_first_name": "TERRI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "773-583-4455",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "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 Apr 19, 2008; 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.