Prairie Valley Dental, P.C.

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

PRAIRIE VALLEY DENTAL, P.C.

Practice address

108 Valley Dr Unit H
Elburn, IL 60119-8872

Phone

(630) 365-1675

Fax

(630) 365-1678

NPI assigned

Aug 24, 2007

Last updated

Aug 24, 2007By 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. Kevin Michael Enberg, D.D.S.

Title

President

Phone

(630) 365-1675

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1187913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187913600000",
    "number": "1346433000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 VALLEY DR UNIT H",
            "city": "ELBURN",
            "state": "IL",
            "postal_code": "601198872",
            "telephone_number": "630-365-1675",
            "fax_number": "630-365-1678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 VALLEY DR UNIT H",
            "city": "ELBURN",
            "state": "IL",
            "postal_code": "601198872",
            "telephone_number": "630-365-1675",
            "fax_number": "630-365-1678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE VALLEY DENTAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-24",
        "last_updated": "2007-08-24",
        "status": "A",
        "authorized_official_last_name": "ENBERG",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-365-1675",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lazarina Kostova Paraskevova, CSA
• Heather R. Partoll, PTA
• Jaymin A Patel, PHARM. D.
• Alyssa Pennington
• Joy Marie Powell, MSPT, CERT. MDT
• Airianna Quintanilla, MS, LSW, CADC
• Andrea Rauch, PHARMD
• Karen Frances Rink, OTR/L
• Robert B Davidson DDS PC
• Kirstie Ruckoldt, LCSW

• Dental Clinic/Center in Elburn, IL
• Providers in Elburn, 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 Aug 24, 2007; 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.