Kedzie Dentistry LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

KEDZIE DENTISTRY LLC

Practice address

5430 S Kedzie Ave
Chicago, IL 60632-2620

Phone

(773) 295-2523

NPI assigned

Nov 28, 2025

Organization subpart

No

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

Authorized official

Name

Prasanth Dommaraju, DMD

Title

Director

Phone

(630) 247-7216

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1764288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764288000000",
    "number": "1871455832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5430 S KEDZIE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606322620",
            "telephone_number": "773-295-2523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5430 S KEDZIE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606322620",
            "telephone_number": "773-295-2523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEDZIE DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-11-28",
        "last_updated": "2025-11-28",
        "certification_date": "2025-11-28",
        "status": "A",
        "authorized_official_last_name": "DOMMARAJU",
        "authorized_official_first_name": "PRASANTH",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "630-247-7216",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tanya Kechker, O.D.
• Sabrina Marie Keck, D.P.T.
• Susan A. Kecskes, M.D.
• Kedzie 47 Dental LLC
• Kedzie Dental Clinic
• Kedzie Drugs Inc
• Kedzie Medical Clinic Inc
• Anna Kedzierska
• Alla Kedzierski
• Cezary S. Kedzierzawski

• General Practice Dentistry in Chicago, IL
• Providers in Chicago, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 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.

Verify at the official NPI Registry.