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MT. GREENWOOD DENTAL CLINIC
NPI 1558637926
Dentist in Chicago, IL

Active since March 29, 2012CLIA 14D1036061 · Waiver
3135 W 111TH ST, CHICAGO, IL 60655(773) 238-4451 Get Directions Write a Review

NPPES record last updated: March 29, 2012. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Mt. Greenwood Dental Clinic NPPES

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

MT. GREENWOOD DENTAL CLINIC (NPI 1558637926) is a healthcare organization registered as a dentist in Chicago, Illinois and active in the NPI registry since March 2012. The organization holds a CLIA Waiver certificate valid through January 18, 2027 and lists Kenneth Brocker, Owner, as its authorized official.

NPPES Registry Identity

NPI1558637926
Entity TypeOrganization
Primary Taxonomy122300000X
Legal Business NameMT. GREENWOOD DENTAL CLINIC
Location Address3135 W 111TH STChicago, IL 60655-2223
Mailing Address3135 W 111th StChicago, IL 60655-2223
Phone(773) 238-4451
Organization SubpartNo
Authorized OfficialKenneth BrockerOwner · (773) 238-4451
Enumeration DateMarch 29, 2012
✔ NPI 1558637926 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License✔ Licensed in IL · 019016104
Definition
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
3135 W 111TH ST, Chicago, IL 60655
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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 SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D1036061

Mt Greenwood · Chicago, IL
Active · expires Jan 18, 2027
CLIA Number14D1036061
Laboratory TypeEnd Stage Renal Disease Dialysis Facility
Certificate Effective DateJanuary 19, 2025
Certificate Expiration DateJanuary 18, 2027
Laboratory DirectorMohamad Barakat
Laboratory Phone(773) 445-0558
Laboratory LocationMt Greenwood3401 W 111th Street, Chicago, IL 60655
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

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

GEORGE M NISTA O.D.
Optometrist
3135 W 111TH ST
CHICAGO, IL 60655
Cook County (773) 233-4448
DR. KENNETH ROBERT BROCKER DDS
Dentist
3135 W 111TH ST
CHICAGO, IL 60655
Cook County (773) 238-4451
DR. GEORGE JAMES JILEK III D.D.S
Dentist
3135 W 111TH ST
CHICAGO, IL 60655
Cook County (773) 238-4451

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 Mt. Greenwood Dental Clinic's NPI number?

The NPI number for Mt. Greenwood Dental Clinic is 1558637926. It was assigned to this organization in the NPPES registry on March 29, 2012.

Where is Mt. Greenwood Dental Clinic located?

Mt. Greenwood Dental Clinic is located at 3135 W 111th St, Chicago, IL 60655. The listed phone number is (773) 238-4451.

What is Mt. Greenwood Dental Clinic's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Does Mt. Greenwood Dental Clinic hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D1036061) is associated with this NPI, valid through January 18, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Mt. Greenwood Dental Clinic was last updated on March 29, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.