DR. PETER S DOMAGALA (NPI# 1356415673) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356415673 |
| Entity Type | Individual |
| Full Name | DR. PETER S DOMAGALA |
| Credential | DDS |
| Practice Address |
6121 Washington St Suite 203 Gurnee IL 60031-5305 |
| Practice Telephone | 8476623414 |
| Practice Fax Number | 8476623487 |
| Mailing Telephone | 8476623414 |
| Mailing Fax Number | 8476623487 |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
IL | Dental Providers |
| Street Address |
6121 WASHINGTON ST SUITE 203 |
| City | GURNEE |
| State | IL |
| Zip Code | 60031-5305 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396292884 | Dental Associates of South Ridge, P.C. | Dentist | 6121 Washington St, #202, Gurnee, IL 60031-5305 | 2016-09-01 |
| 1538576194 | Naheed Yasmeen | Dentist | 6121 Washington St, #203, Gurnee, IL 60031-5305 | 2014-07-16 |
| 1083937742 | Apollo Dental Clinic, LLC | Dentist | 6121 Washington St, Suite 203, Gurnee, IL 60031-5305 | 2010-03-10 |
| 1689887861 | Chris P. Ullmann | Dentist | 6121 Washington St, Suite 202, Gurnee, IL 60031-5305 | 2007-05-07 |
| 1033284831 | Prairie Orthodontics PC | Dentist | 6121 Washington St, Suite 204, Gurnee, IL 60031 | 2006-11-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881174720 | Rockelle Waggoner | Behavioral Analyst | 489 Tanglewood Dr, Gurnee, IL 60031 | 2018-08-20 |
| 1316434376 | Lake County Internal Medicine Assoc LLC | Non-Pharmacy Dispensing Site | 15 Tower Ct., Ste 190, Gurnee, IL 60031 | 2018-04-16 |
| 1588163364 | Advanced Endodontics, PC | Dentist | 103 S. Greenleaf Street, Suite K, Gurnee, IL 60031 | 2018-02-07 |
| 1578081550 | Northshore Medical Consultants, Ltd | Family Medicine | 1425 Hunt Club Rd. #302, Gurnee, IL 60031 | 2017-08-30 |
| 1336678739 | Sarah Beth Fugelseth | Nurse Practitioner | 1445 N Hunt Club Rd Ste 304, Gurnee, IL 60031 | 2017-06-08 |
| 1174079867 | Lifecarepros, LLC | In Home Supportive Care | 223 North Route 21, Gurnee, IL 60031 | 2016-09-01 |
| 1740733195 | Ryan Lee Winslow | Chiropractor | 6021 Washington St, Unit B, Gurnee, IL 60031 | 2016-08-02 |
| 1891129599 | Smart Scan Mri, LLC | Clinic/Center | 350 S. Greenleaf, Suite 401, Gurnee, IL 60031 | 2013-08-29 |
| 1568720076 | Yudelca Romano | Genetic Counselor, MS | 1125 Tri State Parkway, Gurnee, IL 60031 | 2012-05-03 |
| 1558637348 | Laura E Novak | Social Worker | 4212 Old Grand Avenue, Gurnne, IL 60031 | 2012-03-27 |
| Find all providers in zip 60031 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558515726 | John C Anderson | Dentist | 135 N Greenleaf St, Suite 202, Gurnee, IL 60031-3393 | 2008-11-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891309399 | Dominik Dubravec Dds Mmsc PC | Dentist | 555 W Court St Ste 202, Kankakee, IL 60901-3674 | 2020-09-02 |
| 1598374167 | Dubravec Periodontal Specialists PC | Dentist | 20635 Abbey Woods Ct N Ste 203, Frankfort, IL 60423-3186 | 2020-07-29 |
| 1972145183 | Dental Dream Team Associates LLC Yetta Mccullom Sole Mbr | Dentist | 820 E 87th St Ste 201, Chicago, IL 60619-6256 | 2019-10-09 |
| 1083192389 | Amirreza Ghassemi | Dentist | 2800 College Ave Bldg 285, Alton, IL 62002-4742 | 2018-07-30 |
| 1508355678 | Periodontal Associates, LLP | Dentist | 845 N Michigan Ave Ste 940w, Chicago, IL 60611-2216 | 2018-05-04 |
| 1043750714 | Bloomingdale Dental Rez, PC | Dentist | 1 Tiffany Pt Ste 209, Bloomingdale, IL 60108-2916 | 2017-03-01 |
| 1114398831 | Dubravec Periodontal Associates, PC | Dentist | 1900 Spring Rd, Suite 205, Oak Brook, IL 60523-1447 | 2015-10-08 |
| 1689059297 | Amer Atassi | Dentist | 6224 S Elm St, Burr Ridge, IL 60527-5228 | 2015-07-24 |
| 1013304724 | Elliott T. Deweese | Dentist | 7447 W Talcott Ave., Suite 227, Chicago, IL 60631 | 2015-04-20 |
| 1215345939 | Mark Kolozenski, Dds, Ms, PC | Dentist | 10083 W Lincoln Hwy, Frankfort, IL 60423-1272 | 2014-07-25 |
| Find all providers with the same taxonomy | ||||
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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.