ICO DENTAL, LLC – NPI #1144958067
Clinic/Center

ICO DENTAL, LLC is an AHC clinic located in CHICAGO, IL. NPPES has assigned the NPI number 1144958067 to ICO DENTAL, LLC on August 09, 2022. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 261QD0000X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Dental

Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for ICO DENTAL, LLC below.

NPI Profile for
ICO DENTAL, LLC

NPI Number
1144958067
Enumeration Date

(about 4 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
ICO DENTAL, LLC
Primary location
4200 W PETERSON AVE STE 136
CHICAGO, IL 60646-6052
Phone: (773) 286-5286 Fax:
Mailing address
343 W WOLF POINT PLZ UNIT 1404
CHICAGO, IL 60654-0103
Phone: (713) 382-8654 Fax:
Organization Subpart
No
Authorized Official
THAER AL AZZAWI
OWNER
Phone: (713) 382-8654
Updated
Certification Date
Aug 09, 2022

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QD0000X
- Clinic/Center / Dental (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.