Active NPI
Bridgeport Dental Specialists LLC
- Orthodontics and Dentofacial Orthopedics Dentistry
- Chicago, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 019027652
- Legal business name
- BRIDGEPORT DENTAL SPECIALISTS LLC
- Practice address
- 2959 S Wallace St
Chicago, IL 60616-3034 - Phone
- (312) 791-0920
- Fax
- (312) 842-5338
- NPI assigned
- Sep 13, 2010
- Last updated
- Sep 13, 2010
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Steven Vongluekiat
- Title
- Owner
- Phone
- (312) 791-0920
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 019027652 | IL | Primary |
Addresses
Primary practice location
2959 S Wallace St
Chicago, IL 60616-3034
Mailing address
2959 S Wallace St
Chicago, IL 60616-3034
Phone (312) 791-0920
National Provider Directory
National Provider Directory- Tax ID family
- Bridgeport Dental Specialists LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Dentist
- Chicago, IL
- NPI 1891025540
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Dentist
- Chicago, IL
- NPI 1902001613
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1284336000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1284336000000",
"number": "1932416898",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2959 S WALLACE ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606163034",
"telephone_number": "312-791-0920",
"fax_number": "312-842-5338"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2959 S WALLACE ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606163034",
"telephone_number": "312-791-0920",
"fax_number": "312-842-5338"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BRIDGEPORT DENTAL SPECIALISTS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2010-09-13",
"last_updated": "2010-09-13",
"status": "A",
"authorized_official_last_name": "VONGLUEKIAT",
"authorized_official_first_name": "STEVEN",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "312-791-0920",
"authorized_official_name_prefix": "Dr."
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "IL",
"license": "019027652",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
- Mary Catherine Bridgeland, LPC
- Madeline Bridgeman, PT, DPT
- Shikota Bridgemon
- Bridgepoint Psychology Center Inc.
- Bridgeport Dental Smiles LLC
- Bridgeport Dental Specialists, LLC
- Bridgeport Eye Care, LLC (Miami Optical)
- Bridgeport Family Medical Center S.C.
- Bridgeport Family Medical Center S.C.
- Bridgeport Foot Care, LTD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.