Unknown Individual – General Practice Dentistry, NPI 1174552301

Unknown Individual is a healthcare provider. based in River forest, Illinois. specializing in General Practice Dentistry. They hold a License No. 190-12991 (IL). The NPI Number for Unknown Individual is 1174552301

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1174552301
Phone
(708) 386-8066
Address
7353 LAKE ST
Deactivation Date
29 March 2022
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 7353, Lake Street, River Forest, Cook County, Illinois, 60305, United States

    RIVER FOREST, IL 603052214

    Phone: (708) 386-8066

    Fax: (708) 714-3137

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 60305)

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Reviews

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Frequently asked questions

Is there an official ID for Unknown Individual in U.S. healthcare records?
The official identifier for Unknown Individual is NPI 1174552301.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with General Practice Dentistry in the directory — Clinical services aligned with this taxonomy classification.
Where in Illinois is Unknown Individual registered?
Use River Forest, Illinois as the headline location for Unknown Individual here.
What does 2 location(s) imply?
2 practice locations appear in the available data.

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