NPIMap

Organization Active NPI

Sam Dauahera DDS PC

Doing business as Edgebrook Dental Associates

  • General Practice Dentistry
  • Chicago, IL
National Provider Identifier
1992046205
Registry record updated Mar 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019027577 Issued in IL
Legal business name
SAM DAUAHERA DDS PC
Doing business as
Edgebrook Dental Associates
Practice address
5131 W Devon Ave
Chicago, IL 60646-4217
Phone
(773) 631-8717
Fax
(773) 631-7781
NPI assigned
Mar 12, 2013
Last updated
Mar 12, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2013

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

Authorized official

Name
Dr. Sam Dauahera, DDSNPI 1609046705
Title
Owner
Phone
(773) 456-5659

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)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 019027577 IL Primary

Addresses

Primary practice location

5131 W Devon Ave
Chicago, IL 60646-4217

Mailing address

5131 W Devon Ave
Chicago, IL 60646-4217
Phone (773) 631-8717

Other names 1

  • Edgebrook Dental Associates Doing business as

National Provider Directory

National Provider Directory

Locations

5131 W Devon Ave
Chicago, IL 60646
Phone (773) 631-8717

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1363046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363046400000",
    "number": "1992046205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5131 W DEVON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606464217",
            "telephone_number": "773-631-8717",
            "fax_number": "773-631-7781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5131 W DEVON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606464217",
            "telephone_number": "773-631-8717",
            "fax_number": "773-631-7781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAM DAUAHERA DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-12",
        "last_updated": "2013-03-12",
        "status": "A",
        "authorized_official_last_name": "DAUAHERA",
        "authorized_official_first_name": "SAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-456-5659",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019027577",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edgebrook Dental Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Mar 12, 2013; 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.