Pacita Marie Pumilia, B.S.D.D.S.

Key facts

NPI

1154499788

Entity type

Individual (NPI type 1)

Primary specialty

General Practice Dentistry 1223G0001X

Practice address

755 S Mulford Rd
Rockford, IL 61108-4208

Phone

(815) 398-2410

Fax

(815) 398-2620

NPI assigned

Dec 1, 2006

Sex

Female

Sole proprietor

Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pumilia Family Dental LLC Customized Equipment (DME) · Rockford, IL · NPI 1679977458
  NPD Authorized official

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1154499788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "755 S MULFORD RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611084208",
            "telephone_number": "815-398-2410",
            "fax_number": "815-398-2620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 S MULFORD RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611084208",
            "telephone_number": "815-398-2410",
            "fax_number": "815-398-2620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUMILIA",
        "first_name": "PACITA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "B.S.D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

• Daniel Psaltis, DC
• Nick D Psaltis, D.C.
• Psychiatric Associates of Rockford SC
• Psychiatric Clinics of Northern Illinois PC
• Pumilia Family Dental LLC
• Michael Puruckherr, MD
• Denise Purvis, LCPC
• Noel M Pycior, FNP-BC
• Patrick J Pyka, MPT
• Edward C Pyun Jr., MD

All providers in Rockford, IL · General Practice Dentistry in Illinois