Freeport Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019027024 Issued in IL

Legal business name

FREEPORT DENTAL

Practice address

1450 S West Ave
Freeport, IL 61032-6351

Phone

(815) 656-4060

Fax

(815) 656-2324

NPI assigned

Oct 5, 2015

Organization subpart

Yes

Parent organization

SHADYOAK DENTALAs reported in NPPES

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

Authorized official

Name

Scott Bares

Title

Owner

Phone

(815) 656-4060

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Naramsin Ashoormaram, DMD

  • General Practice Dentistry
  • Chandler, AZ
  • NPI 1013402841
  NPD (past)

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

{
    "created_epoch": "1444003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444003200000",
    "number": "1891165643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 S WEST AVE",
            "city": "FREEPORT",
            "state": "IL",
            "postal_code": "610326351",
            "telephone_number": "815-656-4060",
            "fax_number": "815-656-2324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 S WEST AVE",
            "city": "FREEPORT",
            "state": "IL",
            "postal_code": "610326351",
            "telephone_number": "815-656-4060",
            "fax_number": "815-656-2324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREEPORT DENTAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHADYOAK DENTAL",
        "enumeration_date": "2015-10-05",
        "last_updated": "2015-10-05",
        "status": "A",
        "authorized_official_last_name": "BARES",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-656-4060"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019027024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GENERAL DENISTRY",
            "identifier": "1164580734",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Frances House Inc
• Frances House Inc
• Leon Freeburg
• Freeport Care LLC
• Freeport Chiropractic PLLC
• Freeport District 145
• Freeport Ear Nose & Throat Associates LTD
• Freeport Family Chiropractic & Acupuncture Inc
• Freeport Family Dental Care, P.C.
• Freeport Family Dental, LLC

• General Practice Dentistry in Freeport, IL
• Providers in Freeport, 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 Oct 5, 2015; 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.