NPIMap

Organization Active NPI

Procare Dental Group, P.C.

Doing business as LakeHills Dentistry

  • Dentist
  • Crystal Lake, IL
National Provider Identifier
1669539904
Registry record updated Jan 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
PROCARE DENTAL GROUP, P.C.
Doing business as
LakeHills Dentistry
Practice address
805 McHenry Ave
Crystal Lake, IL 60014-9794
Phone
(815) 477-2369
Fax
(815) 477-2815
NPI assigned
Jan 3, 2007
Last updated
Jan 23, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
PROCARE DENTAL GROUP, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 23, 2008

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

Authorized official

Name
Dr. Robert G. Brunetti, D.D.S.NPI 1033341615
Title
C.E.O.
Phone
(847) 640-1112

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X IL Primary

Addresses

Primary practice location

805 McHenry Ave
Crystal Lake, IL 60014-9794

Mailing address

605 E Algonquin Rd
Ste 300
Arlington Heights, IL 60005-4373
Phone (847) 640-1112

Other names 1

  • LakeHills Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Procare Dental Group PC15 organizations share this tax ID, including this one
Part of
Procare Dental Group PC

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Locations

805 S McHenry Ave
Crystal Lake, IL 60014
Phone (815) 477-2369

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201046400000",
    "number": "1669539904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 E ALGONQUIN RD",
            "address_2": "STE 300",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600054373",
            "telephone_number": "847-640-1112",
            "fax_number": "847-640-1107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 MCHENRY AVE",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600149794",
            "telephone_number": "815-477-2369",
            "fax_number": "815-477-2815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROCARE DENTAL GROUP, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROCARE DENTAL GROUP, P.C.",
        "enumeration_date": "2007-01-03",
        "last_updated": "2008-01-23",
        "status": "A",
        "authorized_official_last_name": "BRUNETTI",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "847-640-1112",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LakeHills Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crystal Lake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2008; 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.