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JEFFERSON PARK FAMILY DENTAL LLC
NPI 1417528589
Dentist - General Practice in Chicago, IL

Active since July 08, 2021
4452 N CENTRAL AVE, CHICAGO, IL 60630(773) 777-4800(773) 777-4918 Get Directions Write a Review

NPPES record last updated: January 13, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jan 13, 2023, Jul 8, 2021 (2 updates tracked since 2021).

About Jefferson Park Family Dental Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JEFFERSON PARK FAMILY DENTAL LLC (NPI 1417528589) is a healthcare organization registered as a general practice in Chicago, Illinois and active in the NPI registry since July 2021. The organization lists Robert Cory Stites, Insurance Coordinator-decision One, as its authorized official.

NPPES Registry Identity

NPI1417528589
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NameJEFFERSON PARK FAMILY DENTAL LLC
Location Address4452 N CENTRAL AVEChicago, IL 60630-3302
Mailing Address4452 N Central AveChicago, IL 60630-3302 · (773) 777-4800 · Fax (773) 777-4918
Phone(773) 777-4800
Fax(773) 777-4918
Organization SubpartNo
Authorized OfficialRobert Cory StitesInsurance Coordinator-decision One · (630) 869-5857
Enumeration DateJuly 8, 2021
Last NPPES UpdateJanuary 13, 20232 updates tracked since enumeration
NPPES CertifiedJanuary 13, 2023
✔ NPI 1417528589 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
4452 N CENTRAL AVE, Chicago, IL 60630
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. MICHELE T BOGACKI D.D.S.
Dentist (General Practice)
4452 N CENTRAL AVE
CHICAGO, IL 60630
Cook County (773) 777-4800
MICHELE T BOGACKI DDS, LTD.
Clinic/Center (Dental)
4452 N CENTRAL AVE
CHICAGO, IL 60630
Cook County (773) 777-4800

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jefferson Park Family Dental LLC's NPI number?

The NPI number for Jefferson Park Family Dental LLC is 1417528589. It was assigned to this organization in the NPPES registry on July 8, 2021.

Where is Jefferson Park Family Dental LLC located?

Jefferson Park Family Dental LLC is located at 4452 N Central Ave, Chicago, IL 60630. The listed phone number is (773) 777-4800.

What is Jefferson Park Family Dental LLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Jefferson Park Family Dental LLC was last updated on January 13, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.