Dominik Dubravec DDS MMSC PC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

Legal business name

DOMINIK DUBRAVEC DDS MMSC PC

Practice address

555 W Court St Ste 202
Kankakee, IL 60901-3674

Phone

(815) 932-0554

Fax

(815) 932-0976

NPI assigned

Sep 2, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Dominik Dubravec, DDS, MMSC, PC

Title

Periodontist/Owner

Phone

(815) 932-0554

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1599004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599004800000",
    "number": "1891309399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 W COURT ST STE 202",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609013674",
            "telephone_number": "815-932-0554",
            "fax_number": "815-932-0976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 W COURT ST STE 202",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609013674",
            "telephone_number": "815-932-0554",
            "fax_number": "815-932-0976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOMINIK DUBRAVEC DDS MMSC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-02",
        "last_updated": "2020-09-02",
        "certification_date": "2020-09-02",
        "status": "A",
        "authorized_official_last_name": "DUBRAVEC",
        "authorized_official_first_name": "DOMINIK",
        "authorized_official_title_or_position": "PERIODONTIST/OWNER",
        "authorized_official_telephone_number": "815-932-0554",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MMSC, PC"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Kankakee, IL
• Providers in Kankakee, IL by specialty
• Periodontics in Illinois

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