DENTAL DREAM TEAM ASSOCIATES LLC YETTA MCCULLOM SOLE MBR (NPI# 1972145183) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972145183 |
| Entity Type | Organization |
| Organization Name | DENTAL DREAM TEAM ASSOCIATES LLC YETTA MCCULLOM SOLE MBR |
| Practice Address |
820 E 87th St Ste 201 Chicago IL 60619-6256 |
| Practice Telephone | 7734889072 |
| Practice Fax Number | 8885065697 |
| Mailing Telephone | 7734889072 |
| Mailing Fax Number | 8885065697 |
| Enumeration Date | 2019-10-09 |
| Last Update Date | 2019-10-09 |
| Authorized Official Name | YETTA G MCCULLOM (MANAGER SOLE MEMBER) |
| Authorized Official Telephone | 7734889072 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
Dental Providers |
| Street Address |
820 E 87TH ST STE 201 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60619-6256 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457985061 | Tonia Dorsey | Durable Medical Equipment & Medical Supplies | 951 E 80th Street, Apt 1, Chicago, IL 60619 | 2020-02-24 |
| 1821635509 | Lisa Strader | Technician | 8605 S. Dorchester, Chicago, IL 60619 | 2019-12-02 |
| 1821647579 | Deborah Joves | Technician | 8258 S. Woodlawn Ave, Chicago, IL 60619 | 2019-09-05 |
| 1194372458 | Cognitive Focus Centers, Inc. | Clinic/Center | 901 E 95th St, Chicago, IL 60619 | 2019-08-21 |
| 1588136360 | Zantraquilla Z Madkins | Transportation Broker | 7829 South Wabash, Chicago, IL 60619 | 2018-12-18 |
| 1619447497 | Bria Stanciel | Case Manager/Care Coordinator | 8419 S Cottage Grove, Chicago, IL 60619 | 2018-12-05 |
| 1184153520 | Jordane Kelley | Nurse's Aide | 7339 S Wabash Ave, Chicago, IL 60619 | 2017-06-08 |
| 1205362977 | Kristen Suing | Psychologist | 1111 E 87th St Ste 300, Chicago, IL 60619 | 2017-05-02 |
| 1720525280 | Senior Healthcare Services Inc | Physical Therapist | 9133 South Stoney Island, Chicago, IL 60619 | 2017-01-23 |
| 1932652567 | Md Orthotic & Prosthetic Laboratory, Inc. | Prosthetic/Orthotic Supplier | 1514 E 87th St Lowr Level, Chicago, IL 60619 | 2016-08-01 |
| Find all providers in zip 60619 | ||||
| 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 |
|---|---|---|---|---|
| 1508355678 | Periodontal Associates, LLP | Dentist | 845 N Michigan Ave Ste 940w, Chicago, IL 60611-2216 | 2018-05-04 |
| 1013304724 | Elliott T. Deweese | Dentist | 7447 W Talcott Ave., Suite 227, Chicago, IL 60631 | 2015-04-20 |
| 1417377417 | Kate Quinlin | Dentist | 939 W North Ave Ste 700, Chicago, IL 60642-7839 | 2014-04-17 |
| 1437597598 | Carmen Villasante Graves | Dentist | Rm.458 Mc 859, 801 S. Paulina St, Chicago, IL 60612 | 2013-06-11 |
| 1972781961 | Daniel M Weber | Dentist | 25 E Washington, #1125, Chicago, IL 60602 | 2008-02-01 |
| 1699809202 | Stephen P Russo | Dentist | 25 E. Washington St, Suite 1125, Chicago, IL 60602 | 2007-03-15 |
| 1366572802 | Christine M Gadia | Dentist | 223 W. Jackson Blvd, #1275, Chicago, IL 60606-6908 | 2007-03-06 |
| 1700915105 | Loyola M. Gleason | Dentist | 5945 S Pulaski Rd, Chicago, IL 60629-4550 | 2007-03-04 |
| 1790833192 | Thomas F. Schneider Jr. | Dentist | 4949 W Irving Park Rd Ste D, Chicago, IL 60641-2641 | 2007-01-08 |
| 1336219856 | Periodontics Ltd. | Dentist | 111 N Wabash Ave Ste 919, Chicago, IL 60602-1932 | 2006-11-09 |
| Find all providers in CHICAGO | ||||
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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.