PA DENTAL INCORPORATED (NPI# 1013120005) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013120005 |
| Entity Type | Organization |
| Organization Name | PA DENTAL INCORPORATED |
| Other Organization Name | DOUGLAS DENTAL CENTER |
| Practice Address |
2605a Grand Ave Waukegan IL 60085-2410 |
| Practice Telephone | 8472447779 |
| Mailing Telephone | 8472447779 |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. AJITHA PARUCHURI (PRESIDENT) |
| Authorized Official Telephone | 6302295469 |
| Authorized Official Credential | D.M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
IL | Dental Providers |
| Other Name | Type Code |
|---|---|
| Douglas Dental Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548809858 | Pa Dental Incorporated | Dentist | 630 Milwaukee Ave Ste 130, Glenview, IL 60025-5655 | 2020-01-03 |
| Street Address |
2605A GRAND AVE |
| City | WAUKEGAN |
| State | IL |
| Zip Code | 60085-2410 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285285189 | Allison Rose Matuszewski | Speech-Language Pathologist | Robbie M. Lightfoot, 1721 N Mcaree Rd, Waukegan, IL 60085 | 2019-09-23 |
| 1164985602 | Kristin Kaprak | Speech-Language Pathologist | Thomas Jefferson Middle School, 600 S. Lewis, Waukegan, IL 60085 | 2019-04-11 |
| 1861972317 | Mitchum Smith | Student in an Organized Health Care Education/Training Program | 2025 Washington Street, Waukegan, IL 60085 | 2018-08-15 |
| 1447702998 | Rachel Martinez | Registered Nurse | 3002 Grand Ave., Waukegan, IL 60085 | 2016-11-01 |
| 1831649250 | Kenneth Caples | Specialist/Technologist | 211 S County St, Waukegan, IL 60085 | 2016-10-10 |
| 1033666490 | Catholic Charities of The Archdiocese of Chicago | Community/Behavioral Health | 671 S. Lewis Ave., Waukegan, IL 60085 | 2016-09-02 |
| 1285007757 | Michael Moore | Counselor | 1113 Greenwood Ave, Waukegan, IL 60085 | 2015-11-05 |
| 1740656503 | Emperatriz Guerra | Counselor | 329 N. Genesee Street, Waukegan, IL 60085 | 2015-08-17 |
| 1992189880 | County of Lake | Clinic/Center | 540 S. Mcalister Ave., Waukegan, IL 60085 | 2015-07-10 |
| 1922406354 | Ebele Okonkwor | Nurse Anesthetist, Certified Registered | 1324 N. Sheridan, Waukegan, IL 60085 | 2014-12-17 |
| Find all providers in zip 60085 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| 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. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972023075 | Guillermo Arizona D.d.s PC | Dentist | 2504 Washington St Ste 100, Waukegan, IL 60085-4998 | 2017-06-21 |
| 1801271317 | Annie Mirza | Dentist | 1421 N Lewis Ave, Waukegan, IL 60085-1757 | 2015-07-26 |
| 1053706481 | Jose Villa Dds PC | Dentist | 2841 Grand Ave, Waukegan, IL 60085-2372 | 2015-04-02 |
| 1528474681 | Metrosmiles - Waukegan Dental PC | Dentist | 458 N Green Bay Rd, Waukegan, IL 60085-3149 | 2014-07-09 |
| 1023458502 | Waukegan Family Family | Dentist | 338 S. Greenbay Rd., Waukegan, IL 60085-4850 | 2013-06-28 |
| 1972736247 | Georgia A Williams | Dentist | 2504 Washington St., Suite 500, Waukegan, IL 60085-4983 | 2009-09-02 |
| 1245487792 | Dental Experts, LLC | Dentist | 2821 Grand Ave, Waukegan, IL 60085-2372 | 2008-08-26 |
| 1114139540 | Martha E Diaz | Dentist | 1611 Grand Ave, Waukegan, IL 60085-3605 | 2007-05-06 |
| 1649399593 | Greenwood Dental Associates, Ltd. | Dentist | 609 W Greenwood Ave, Waukegan, IL 60087-5000 | 2007-03-29 |
| 1639225873 | Egon Benedict Schein | Dentist | 218 W Madison St, Waukegan, IL 60085-4314 | 2007-01-27 |
| Find all providers in WAUKEGAN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.