DENTAL PROFESSIONALS OF ILLINOIS, P.C. (NPI# 1053713966) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053713966 |
| Entity Type | Organization |
| Organization Name | DENTAL PROFESSIONALS OF ILLINOIS, P.C. |
| Other Organization Name | MACHESNEY PARK FAMILY DENTAL |
| Practice Address |
1411 W Lane Rd Ste B Machesney Park IL 61115 |
| Practice Telephone | 8159819075 |
| Mailing Telephone | 8159819075 |
| Enumeration Date | 2014-09-23 |
| Last Update Date | 2014-09-23 |
| Authorized Official Name | LINDSAY BEARDEN (CREDENTIALING COORDINATOR) |
| Authorized Official Telephone | 2175405699 |
| Is Organization Subpart | Y |
| Parent Organization Name | DENTAL PROFESSIONALS OF ILLINOIS, P.C. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| Other Name | Type Code |
|---|---|
| Machesney Park Family Dental | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669092177 | Dental Professionals of Illinois, P.C. | Dentist | 3419 Orchard Rd, Oswego, IL 60543-5005 | 2020-04-24 |
| 1790262434 | Dental Professionals of Illinois, P.C. | Dentist | 1402 S Us Highway 12, Fox Lake, IL 60020-1252 | 2018-07-25 |
| 1255884623 | Dental Professionals of Illinois, P.C. | Dentist | 2740 Prairie Crossing Drive, Springfield, IL 62711 | 2016-08-02 |
| 1043609167 | Dental Professionals of Illinois, P.C. | Dentist | 9990 W 190th St, Suite D, Mokena, IL 60448-8188 | 2015-01-13 |
| 1144623273 | Dental Professionals of Illinois, P.C. | Dentist | 540 W Walnut St, Oglesby, IL 61348-1400 | 2014-10-03 |
| 1346651577 | Dental Professionals of Illinois, P.C. | Dentist | 1490 Douglas Rd, Oswego, IL 60543-5106 | 2014-05-09 |
| 1972925584 | Dental Professionals of Illinois, P.C. | Dentist | 6631 Grand Ave Ste 1, Gurnee, IL 60031-5284 | 2014-01-16 |
| 1386985380 | Dental Professionals of Illinois, P.C. | Dentist | 368 W. Washington St., East Peoria, IL 61611 | 2013-03-15 |
| 1871842112 | Dental Professionals of Illinois, P.C. | Dentist | 12605 Troxler Ave, Highland, IL 62249 | 2012-08-31 |
| 1821242603 | Dental Professionals of Illinois, P.C. | Dentist | 1840 Dekalb Ave, Suite B, Sycamore, IL 60178 | 2008-11-06 |
| Street Address |
1411 W LANE RD STE B |
| City | MACHESNEY PARK |
| State | IL |
| Zip Code | 61115 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033675087 | Mary B O'meara | Nurse Practitioner | 9721 N Alpine, Machesney Park, IL 61115 | 2019-02-14 |
| 1518486398 | Jordyn Morris | Speech-Language Pathologist | 710 Ralston Rd, Machesney Park, IL 61115 | 2017-09-13 |
| 1922326271 | Mitalkumar K Patel | Dentist | 1363 W. Lane Road, Machesney Park, IL 61115 | 2010-05-12 |
| 1720134802 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 1349 W Lane Rd, Machesney Park, IL 61115 | 2007-01-25 |
| 1710371471 | Usv Optical Inc. | Eyewear Supplier (Equipment, not the service) | 1770 W Lane Rd, Machesney, IL 61115 | 2015-03-20 |
| 1225436546 | Susan Lynn Sherbon | Community/Behavioral Health | 251 Brentwood Rd, Machesney Park, IL 61115-1064 | 2014-12-18 |
| 1174872519 | Dana Lynn Slabaugh | Physical Therapist | 10510 Ventura Blvd, Machesney Park, IL 61115-1263 | 2012-08-30 |
| 1073590204 | Terry Buzzard | Family Medicine | 11475 N 2nd St, Machesney Park, IL 61115-1285 | 2005-12-29 |
| 1609475672 | Meaghan Elizabeth Reed | Physician Assistant | 11475 N 2nd St, Machesney Park, IL 61115-1285 | 2020-10-21 |
| 1073098380 | Emily Catherine Lutgen | Physician Assistant | 11475 N 2nd St, Machesney Park, IL 61115-1285 | 2018-10-02 |
| Find all providers in zip 61115 | ||||
| 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 |
|---|---|---|---|---|
| 1801183215 | Mitul V Patel | Dentist | 1564 W Lane Rd, Machesney Park, IL 61115-1903 | 2011-07-06 |
| 1659501658 | Dental Experts, LLC | Dentist | 1363 W Lane Rd, Machesney Park, IL 61115-1621 | 2009-07-24 |
| 1285794560 | Nathan William Mogren | Dentist | 7912 N 2nd St, Machesney Park, IL 61115-2812 | 2006-12-09 |
| 1578633178 | Kenneth M Lutsch,dds,ltd | Dentist | 619 Harlem Rd, Machesney Park, IL 61115-2429 | 2006-11-09 |
| 1578112322 | You Seen Seo | Dentist | 1363 W Lane Rd, Machesney Park, IL 61115-1621 | 2019-09-04 |
| 1417470402 | Vanja Cosic | Dentist | 1564 W Lane Rd, Machesney Park, IL 61115-1903 | 2017-07-21 |
| 1215387113 | Tommy John Castillo Sagadraca | Dentist | 1564 W Lane Rd, Machesney Park, IL 61115-1903 | 2016-06-21 |
| 1881979466 | John Mannelly | Dentist | 1363 W Lane Rd, Machesney Park, IL 61115-1621 | 2011-10-14 |
| 1851415376 | Kenneth Michael Lutsch | Dentist | 619 Harlem Rd, Machesney Park, IL 61115-2429 | 2007-03-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104425230 | Sundeep Franklin Dmd & Daiana Capota Dmd Pllc | Dentist | 320 N Mclean Blvd Ste B, Elgin, IL 60123-3220 | 2020-10-20 |
| 1801403555 | Stephanie Elizabeth Miller | Dentist | 2220 Sisters Ave, Naperville, IL 60564-4394 | 2020-09-27 |
| 1417564121 | Gursimran Reen, Dmd LLC | Dentist | 29 S Webster St Ste 108, Naperville, IL 60540-5353 | 2020-09-26 |
| 1285240531 | Summit Dental Center LLC | Dentist | 7710 W 62nd Pl, Summit, IL 60501-1702 | 2020-09-22 |
| 1295340628 | Karina Valentin | Dentist | 1534 N Oakley Blvd Apt 3f, Chicago, IL 60622-1783 | 2020-09-11 |
| 1932713583 | Kevin G Reardon | Dentist | 479 S Spring Rd, Elmhurst, IL 60126-3857 | 2020-09-01 |
| 1831702307 | Sms Dental LLC | Dentist | 17727 Halsted St, Homewood, IL 60430 | 2020-08-25 |
| 1548870884 | Daniel Patrick Jurgens | Dentist | 2 N Country Club Rd Ste 2, Decatur, IL 62521-4174 | 2020-08-02 |
| 1184233934 | Shawna Jade Dudovitz | Dentist | 309 Tamarack Ln, Shiloh, IL 62269-2993 | 2020-07-28 |
| 1417565748 | Robert Hails | Dentist | 3540 N Belt W Ste B, Belleville, IL 62226-5975 | 2020-07-22 |
| Find all providers with the same taxonomy | ||||
| City | MACHESNEY PARK |
| Zip Code | 61115 |
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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.