Pumilia Family Dental LLC

Key facts

NPI

1679977458

Entity type

Organization (NPI type 2)

Primary specialty

Customized Equipment (DME) 332BC3200X

License

019021788 (IL)

Legal business name

PUMILIA FAMILY DENTAL LLC

Practice address

755 S Mulford Rd
Rockford, IL 61108-4208

Phone

(815) 398-2410

Fax

(815) 398-2620

NPI assigned

Oct 22, 2014

Organization subpart

No

Authorized official

Name

Pacita Marie Pumilia, DDS, DIPLOMATE ABDSM NPI 1154499788

Title

Dentist

Phone

(815) 398-2410

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Pacita Marie Pumilia, B.S.D.D.S. General Practice Dentistry · Rockford, IL · NPI 1154499788
  NPD Authorized official

Medicare participation

Medicare fee-for-service enrollment

Enrolled in IL

Medicare enrollment records

National Provider Directory

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 22, 2018.

{
    "created_epoch": "1413936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516579200000",
    "number": "1679977458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "755 S MULFORD RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611084208",
            "telephone_number": "815-398-2410",
            "fax_number": "815-398-2620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 S MULFORD RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611084208",
            "telephone_number": "815-398-2410",
            "fax_number": "815-398-2620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUMILIA FAMILY DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-22",
        "last_updated": "2018-01-22",
        "status": "A",
        "authorized_official_last_name": "PUMILIA",
        "authorized_official_first_name": "PACITA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "815-398-2410",
        "authorized_official_credential": "DDS, DIPLOMATE ABDSM"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "319.010939",
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "IL",
            "license": "019021788",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

• Landon S Pryor, M.D.
• Daniel Psaltis, DC
• Nick D Psaltis, D.C.
• Psychiatric Associates of Rockford SC
• Psychiatric Clinics of Northern Illinois PC
• Pacita Marie Pumilia, B.S.D.D.S.
• Michael Puruckherr, MD
• Denise Purvis, LCPC
• Noel M Pycior, FNP-BC
• Patrick J Pyka, MPT

All providers in Rockford, IL · Customized Equipment (DME) in Illinois