NPIMap

Organization Active NPI

Procare Dental Group, P.C.

Doing business as LakeSide Dentistry

  • Dentist
  • Evanston, IL
National Provider Identifier
1841357084
Registry record updated Jun 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
060-008822 Issued in IL
Legal business name
PROCARE DENTAL GROUP, P.C.
Doing business as
LakeSide Dentistry
Practice address
820 Davis St
Ste 460
Evanston, IL 60201-4431
Phone
(847) 332-2226
Fax
(847) 332-1683
NPI assigned
Jan 3, 2007
Organization subpart
Yes
Parent organization
PROCARE DENTAL GROUP, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 18, 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.
Title
C.E.O.
Phone
(847) 640-1112

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 060-008822 IL Primary

Addresses

Primary practice location

820 Davis St
Ste 460
Evanston, IL 60201-4431

Mailing address

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

Other names 1

  • LakeSide 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

820 Davis St
Ste 460
Evanston, IL 60201
Phone (847) 332-2226

Practitioners & affiliated clinicians

Practitioners 6

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": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213747200000",
    "number": "1841357084",
    "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": "820 DAVIS ST",
            "address_2": "STE 460",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014431",
            "telephone_number": "847-332-2226",
            "fax_number": "847-332-1683"
        }
    ],
    "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": "2008-06-18",
        "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": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "060-008822",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LakeSide Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Evanston, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 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.