NPIMap

Organization Active NPI

Dental Diagnostic Imaging

  • Oral and Maxillofacial Radiology Dentistry
  • Chicago, IL
National Provider Identifier
1942653738
Registry record updated Jul 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Radiology DentistryTaxonomy code 1223X0008X
License
019.030434 Issued in IL
Legal business name
DENTAL DIAGNOSTIC IMAGING
Practice address
1201 S Prairie Ave
4901
Chicago, IL 60605-3325
Phone
(312) 966-6307
NPI assigned
Jul 18, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2016

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

Authorized official

Name
Dr. Mitra Sadrameli, DMD, MS
Title
President
Phone
(312) 966-6307

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Radiology DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0008X 019.030434 IL Primary

Addresses

Primary practice location

1201 S Prairie Ave
4901
Chicago, IL 60605-3325

Mailing address

1201 S Prairie Ave
4901
Chicago, IL 60605-3325
Phone (312) 966-6307

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1468800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468800000000",
    "number": "1942653738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 S PRAIRIE AVE",
            "address_2": "4901",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606053325",
            "telephone_number": "312-966-6307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 S PRAIRIE AVE",
            "address_2": "4901",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606053325",
            "telephone_number": "312-966-6307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL DIAGNOSTIC IMAGING",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-18",
        "last_updated": "2016-07-18",
        "status": "A",
        "authorized_official_last_name": "SADRAMELI",
        "authorized_official_first_name": "MITRA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "312-966-6307",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, MS"
    },
    "taxonomies": [
        {
            "code": "1223X0008X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Radiology",
            "state": "IL",
            "license": "019.030434",
            "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 Jul 18, 2016; 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.