NPIMap

Organization Active NPI

Dental Dream Team Associates LLC Yetta McCullom Sole MBR

  • Periodontics
  • Chicago, IL
National Provider Identifier
1972145183
Registry record updated Oct 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
Legal business name
DENTAL DREAM TEAM ASSOCIATES LLC YETTA MCCULLOM SOLE MBR
Practice address
820 E 87TH St Ste 201
Chicago, IL 60619-6256
Phone
(773) 488-9072
Fax
(888) 506-5697
NPI assigned
Oct 9, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2019

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

Authorized official

Name
Yetta G McCullom, DDSNPI 1285884791
Title
Manager Sole Member
Phone
(773) 488-9072

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X Primary

Addresses

Primary practice location

820 E 87TH St Ste 201
Chicago, IL 60619-6256

Mailing address

820 E 87TH St Ste 201
Chicago, IL 60619-6256
Phone (773) 488-9072

National Provider Directory

National Provider Directory

Locations

820 E 87th St
Ste 201
Chicago, IL 60619
Phone (773) 488-3738

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1570579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570579200000",
    "number": "1972145183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 E 87TH ST STE 201",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606196256",
            "telephone_number": "773-488-9072",
            "fax_number": "888-506-5697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 E 87TH ST STE 201",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606196256",
            "telephone_number": "773-488-9072",
            "fax_number": "888-506-5697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL DREAM TEAM ASSOCIATES LLC YETTA MCCULLOM SOLE MBR",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-09",
        "last_updated": "2019-10-09",
        "status": "A",
        "authorized_official_last_name": "MCCULLOM",
        "authorized_official_first_name": "YETTA",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "MANAGER SOLE MEMBER",
        "authorized_official_telephone_number": "773-488-9072",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "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 Oct 9, 2019; 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.