NPIMap

Organization Active NPI

Premier Dental Clinic, LLC

  • General Practice Dentistry
  • Aurora, IL
National Provider Identifier
1386815744
Registry record updated Mar 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019024846 Issued in IL
Legal business name
PREMIER DENTAL CLINIC, LLC
Practice address
1264B N Lake St
Aurora, IL 60506-2453
Phone
(630) 801-9028
NPI assigned
Mar 13, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2020

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

Authorized official

Name
Phil Kural
Title
Director Doctor Credentialing
Phone
(312) 274-4526

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 019024846 IL Primary

Addresses

Primary practice location

1264B N Lake St
Aurora, IL 60506-2453

Mailing address

1264B N Lake St
Aurora, IL 60506-2453

National Provider Directory

National Provider Directory
Tax ID family
Premier Dental Clinc LLC2 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.

Locations

1264B N Lake St
Aurora, IL 60506
Phone (630) 801-9028

Practitioners & affiliated clinicians

Practitioners 7

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": "1205366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584662400000",
    "number": "1386815744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1264B N LAKE ST",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605062453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1264B N LAKE ST",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605062453",
            "telephone_number": "630-801-9028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER DENTAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-13",
        "last_updated": "2020-03-20",
        "certification_date": "2020-03-20",
        "status": "A",
        "authorized_official_last_name": "KURAL",
        "authorized_official_first_name": "PHIL",
        "authorized_official_title_or_position": "DIRECTOR DOCTOR CREDENTIALING",
        "authorized_official_telephone_number": "312-274-4526"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019024846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aurora, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 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.