Country Court Dental Care

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

COUNTRY COURT DENTAL CARE

Practice address

1880 W Winchester Rd Ste 113
Libertyville, IL 60048-5321

Phone

(847) 680-5141

Fax

(847) 680-5181

NPI assigned

Oct 11, 2018

Last updated

Oct 11, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Bozena Sutkowski, DMD

Title

Dentist

Phone

(847) 680-5141

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1539216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539216000000",
    "number": "1114492576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1880 W WINCHESTER RD STE 113",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600485321",
            "telephone_number": "847-680-5141",
            "fax_number": "847-680-5181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1880 W WINCHESTER RD STE 113",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600485321",
            "telephone_number": "847-680-5141",
            "fax_number": "847-680-5181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY COURT DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-11",
        "last_updated": "2018-10-11",
        "status": "A",
        "authorized_official_last_name": "SUTKOWSKI",
        "authorized_official_first_name": "BOZENA",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "847-680-5141",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria Coronelli, MS, OTR/L
• Corporate Wellness Partners LLC
• Corporate Wellness Partners LLC
• Amanda Cotto
• Counseling Connection Inc.
• County of Lake (d/b/a Winchester House)
• County of Lake (Lake County Health Department and Community Health Center)
• County of Lake (Lake County Health Department and Community Health Center)
• County of Lake (Lake County Health Department and Community Health Center)
• County of Lake School District 70 (LIBERTYVILLE School District 72)

• Dentist in Libertyville, IL
• Providers in Libertyville, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.