NPIMap

Organization Active NPI

Park Avenue Dental Professionals LLC

  • General Practice Dentistry
  • Libertyville, IL
National Provider Identifier
1245360288
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
PARK AVENUE DENTAL PROFESSIONALS LLC
Practice address
1001 W Park Avenue
Libertyville, IL 60048
Phone
(847) 918-1255
Fax
(847) 918-1280
NPI assigned
Mar 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Kathleen Christie Jaroch, DDSNPI 1306976089
Title
Partner
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: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1001 W Park Avenue
Libertyville, IL 60048

Mailing address

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

National Provider Directory

National Provider Directory

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": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1245360288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 W PARK AVENUE",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "60048",
            "telephone_number": "847-918-1255",
            "fax_number": "847-918-1280"
        },
        {
            "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",
            "fax_number": "847-918-1280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK AVENUE DENTAL PROFESSIONALS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CHRISTIE JAROCH",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "847-918-1255",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Aug 22, 2020; 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.