Felicia S Mata DMD LTD

Primary specialty

DentistTaxonomy code 122300000X

License

019024302 Issued in IL

Legal business name

FELICIA S MATA DMD LTD

Doing business as

Windsor I Dental Care

Practice address

501 N Riverside Dr
Ste 119 Windsor I Dental Care
Gurnee, IL 60031

Phone

(847) 244-7340

Fax

(847) 244-7390

NPI assigned

Nov 1, 2006

Organization subpart

Yes

Parent organization

LOOP DENTAL CARE LLC.As reported in NPPES

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

Authorized official

Name

Dr. Felicia S Mata, DMD

Title

President

Phone

(847) 244-7340

Specialties & licenses 1

Addresses

Other names 1

• Windsor I Dental Care Doing business as

Locations

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342051200000",
    "number": "1417034851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 N RIVERSIDE DR",
            "address_2": "STE 119 WINDSOR I DENTAL CARE",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "60031",
            "telephone_number": "847-244-7340",
            "fax_number": "847-244-7390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 N RIVERSIDE DR",
            "address_2": "STE 119 WINDSOR I DENTAL CARE",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "60031",
            "telephone_number": "847-244-7340",
            "fax_number": "847-244-7390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FELICIA S MATA DMD LTD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LOOP DENTAL CARE LLC.",
        "enumeration_date": "2006-11-01",
        "last_updated": "2012-07-12",
        "status": "A",
        "authorized_official_last_name": "MATA",
        "authorized_official_first_name": "FELICIA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-244-7340",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019024302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Windsor I Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dentist in Gurnee, IL
• Providers in Gurnee, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2012; 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.