Chicago Oral Medicine

Primary specialty

DentistTaxonomy code 122300000X

License

019029193 Issued in IL

Legal business name

CHICAGO ORAL MEDICINE

Practice address

10763 163Rd Place
Orland Park, IL 60467

Phone

(517) 214-4034

NPI assigned

Dec 26, 2012

Organization subpart

No

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

Authorized official

Name

Bassam Ali Issa, DDS

Title

Preseident

Phone

(517) 214-4034

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1356480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1356480000000",
    "number": "1891031647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10763 163RD PL",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604678861",
            "telephone_number": "517-214-4034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10763 163RD PLACE",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "60467",
            "telephone_number": "517-214-4034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICAGO ORAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-26",
        "last_updated": "2012-12-26",
        "status": "A",
        "authorized_official_last_name": "ISSA",
        "authorized_official_first_name": "BASSAM",
        "authorized_official_middle_name": "ALI",
        "authorized_official_title_or_position": "PRESEIDENT",
        "authorized_official_telephone_number": "517-214-4034",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019029193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Orland Park, IL
• Providers in Orland Park, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2012; 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.