NPIMap

Organization Active NPI

Park Avenue Dental Professionals, PC

  • General Practice Dentistry
  • Libertyville, IL
National Provider Identifier
1184119950
Registry record updated Jun 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019029777 Issued in IL
Legal business name
PARK AVENUE DENTAL PROFESSIONALS, PC
Practice address
1001 W. Park Avenue
Libertyville, IL 60048
Phone
(847) 918-1255
NPI assigned
Jun 25, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2018

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

Authorized official

Name
Dr. Meggan Rutledge, DDSNPI 1962815589
Title
Owner
Phone
(847) 918-1255

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 019029777 IL Primary

Addresses

Primary practice location

1001 W. Park Avenue
Libertyville, IL 60048

Mailing address

1001 W Park Ave
Libertyville, IL 60048-2550
Phone (847) 918-1255

Other names 1

  • Meggan L Rutledge, DDS PC Former legal business name

National Provider Directory

National Provider Directory

Locations

1001 W Park Ave
Libertyville, IL 60048
Phone (847) 918-1255

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1529884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529884800000",
    "number": "1184119950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 W PARK AVE",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600482550",
            "telephone_number": "847-918-1255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 W. PARK AVENUE",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "60048",
            "telephone_number": "847-918-1255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK AVENUE DENTAL PROFESSIONALS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-25",
        "last_updated": "2018-06-25",
        "status": "A",
        "authorized_official_last_name": "RUTLEDGE",
        "authorized_official_first_name": "MEGGAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-918-1255",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019029777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meggan L Rutledge, DDS PC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Meggan L Rutledge, DDS PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Libertyville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 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.