Perryville Dentist PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019.026938 Issued in IL

Legal business name

PERRYVILLE DENTIST PC

Practice address

845 S Perryville Rd
Unit 119
Rockford, IL 61108

Phone

(847) 354-0127

NPI assigned

Feb 2, 2016

Last updated

Feb 2, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jabal R Patel, DMD

Title

Owner

Phone

(847) 354-0127

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1454371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454371200000",
    "number": "1730547936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 S PERRYVILLE RD",
            "address_2": "UNIT 119",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "61108",
            "telephone_number": "847-354-0127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 S PERRYVILLE RD",
            "address_2": "UNIT 119",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "61108",
            "telephone_number": "847-354-0127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERRYVILLE DENTIST PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-02",
        "last_updated": "2016-02-02",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "JABAL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-354-0127",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.026938",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margaret S Perrin, LMT
• Matteo Perrone, MD
• Perry K. Tuneberg D.D.S. and Associates
• Cecily Devon Perry
• Perryville Counseling Group PLLC
• Perryville Surgical Associates SC
• Julia R Pesavento, D.M.D.
• Petalber Therapy Services
• Catharin Peters, APRN
• Chloe Peters

• General Practice Dentistry in Rockford, IL
• Providers in Rockford, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2016; 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.