Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jefferson Park Family Dental LLC

Organization General Practice Dentistry · NPI 1417528589

Jefferson Park Family Dental LLC is a General Practice Dentistry in Chicago, Illinois. Registered with an NPI since 2021.

In the registry since
2021
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

4452 N Central Ave
Chicago, IL 60630-3302
Phone: (773) 777-4800
Fax: (773) 777-4918
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X

Record details

NPI number1417528589
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Robert Stites — Insurance Coordinator-Decision One · (630) 869-5857
NPI enumeratedJuly 8, 2021
Last updated in NPPESJanuary 13, 2023
Certification dateJanuary 13, 2023
Mailing address4452 N Central Ave, Chicago, IL 60630-3302

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