Valley Creek Family Dental LTD

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

019029811 Issued in IL

Legal business name

VALLEY CREEK FAMILY DENTAL LTD

Practice address

11244 W Laporte Rd
Mokena, IL 60448

Phone

(708) 479-2203

Fax

(708) 479-2412

NPI assigned

Jul 20, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Patrick Michael Mitsos, DMD

Title

President

Phone

(708) 954-7396

Specialties & licenses 1

Addresses

Tax ID family

Valley Creek Family Dental LTD2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Valley Creek Family Dental LTD

  • Dental Clinic/Center
  • Tinley Park, IL
  • NPI 1386168953
  NPD tax ID

Locations

Practitioners 1

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

• Chris Bernard Gambla, D.D.S.

  • General Practice Dentistry
  • Tinley Park, IL
  • NPI 1720104854
  NPD (past)

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

{
    "created_epoch": "1500508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1215450408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11244 W LAPORTE RD",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "60448",
            "telephone_number": "708-479-2203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11244 W LAPORTE RD",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "60448",
            "telephone_number": "708-479-2203",
            "fax_number": "708-479-2412"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16653 80th Ave",
            "address_purpose": "LOCATION",
            "city": "Tinley Park",
            "state": "IL",
            "postal_code": "604771215",
            "country_code": "US",
            "telephone_number": "708-429-9699",
            "fax_number": "708-429-9886",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VALLEY CREEK FAMILY DENTAL LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-20",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "MITSOS",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-954-7396",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": "019029811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Sean Urbanowski, PHARMD
• Brianna Nicole Uribe
• Alfredo Manuel Urquiola, SA-C
• Usv Optical Inc.
• Megan Kateri Valesey, BCBA
• Stephanie Vanchipurakal, PHARMD
• Michelle Vierk, OTR
• Paige C Villalobos, LCSW
• Oscar Alonso Virla, SA-C
• Vital Ambulance Services LLC

• Dental Clinic/Center in Mokena, IL
• Providers in Mokena, IL by specialty
• Dental Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.