NPIMap

Organization Active NPI

Chicago Dental Spa, LTD.

  • General Practice Dentistry
  • Oak Park, IL
National Provider Identifier
1851529382
Registry record updated Jun 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019.026625 Issued in IL
Legal business name
CHICAGO DENTAL SPA, LTD.
Doing business as
Distinctive Dentistry
Practice address
106 S Ridgeland Ave
#408
Oak Park, IL 60302-4613
Phone
(312) 545-8671
NPI assigned
Jun 23, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2009

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

Authorized official

Name
Dr. Conrad Magno, DDS
Title
President
Phone
(312) 545-8671

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 019.026625 IL Primary

Addresses

Primary practice location

106 S Ridgeland Ave
#408
Oak Park, IL 60302-4613

Mailing address

106 S Ridgeland Ave
#408
Oak Park, IL 60302-4613
Phone (312) 545-8671

Other names 1

  • Distinctive Dentistry Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1245715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245715200000",
    "number": "1851529382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 S RIDGELAND AVE",
            "address_2": "#408",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603024613",
            "telephone_number": "312-545-8671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 S RIDGELAND AVE",
            "address_2": "#408",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603024613",
            "telephone_number": "312-545-8671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICAGO DENTAL SPA, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-23",
        "last_updated": "2009-06-23",
        "status": "A",
        "authorized_official_last_name": "MAGNO",
        "authorized_official_first_name": "CONRAD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "312-545-8671",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.026625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Distinctive Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oak Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2009; 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.