Active NPI
Mohammad H Taheri, DMD
- General Practice Dentistry
- Chicago, IL
National Provider Identifier
1861610842
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019.033505
- Practice address
- 630 W Washington Blvd
Chicago, IL 60661-2117 - Phone
- (312) 939-8550
- NPI assigned
- Apr 23, 2007
- Reactivated
- Jan 28, 2025
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 021.003203 | IL | |
| General Practice Dentistry | 1223G0001X | 019.033505 | IL | Primary |
Addresses
Primary practice location
630 W Washington Blvd
Chicago, IL 60661-2117
Mailing address
630 W Washington Blvd
Chicago, IL 60661-2117
Phone (312) 939-8550
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.033505 | IL | MD | General Practice Dentistry |
| 021.003203 | IL | MD | Prosthodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177286400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738713600000",
"number": "1861610842",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "630 W WASHINGTON BLVD",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606612117",
"telephone_number": "312-939-8550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 W WASHINGTON BLVD",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606612117",
"telephone_number": "312-939-8550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAHERI",
"first_name": "MOHAMMAD",
"middle_name": "H",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-23",
"last_updated": "2025-02-05",
"certification_date": "2025-02-05",
"deactivation_date": "2025-01-19",
"reactivation_date": "2025-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "IL",
"license": "021.003203",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019.033505",
"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 Feb 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.