NPIMap

Organization Active NPI

Cherryvale Dental Center LLC

  • Dental Clinic/Center
  • Rockford, IL
National Provider Identifier
1669094041
Registry record updated May 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
CHERRYVALE DENTAL CENTER LLC
Practice address
1957 Pawlisch Dr
Rockford, IL 61112-1067
Phone
(815) 332-3477
Fax
(815) 332-3470
NPI assigned
May 8, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2020

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

Authorized official

Name
Bart Paul, DDSNPI 1205972585
Title
Sole Member
Phone
(815) 332-3477

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
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

1957 Pawlisch Dr
Rockford, IL 61112-1067

Mailing address

1957 Pawlisch Dr
Rockford, IL 61112-1067
Phone (815) 332-3477

National Provider Directory

National Provider Directory

Locations

1957 Pawlisch Dr
Rockford, IL 61112
Phone (312) 332-3477

Practitioners & affiliated clinicians

Practitioners 1

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": "1588896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588896000000",
    "number": "1669094041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1957 PAWLISCH DR",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611121067",
            "telephone_number": "815-332-3477",
            "fax_number": "815-332-3470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1957 PAWLISCH DR",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611121067",
            "telephone_number": "815-332-3477",
            "fax_number": "815-332-3470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHERRYVALE DENTAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-08",
        "last_updated": "2020-05-08",
        "certification_date": "2020-05-08",
        "status": "A",
        "authorized_official_last_name": "PAUL",
        "authorized_official_first_name": "BART",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "815-332-3477",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 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.