Active NPI
Fadzanai Mukarakate
- General Practice Dentistry
- Freeport, IL
National Provider Identifier
1942589643
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019028829
- Practice address
- 2661 W Stephenson St
Freeport, IL 61032 - Phone
- (815) 233-1215
- Fax
- (815) 801-7652
- NPI assigned
- Aug 11, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019028829 | IL | Primary |
Addresses
Primary practice location
2661 W Stephenson St
Freeport, IL 61032
Mailing address
3122 W Kunkle Blvd
Unit #4
Freeport, IL 61032
Phone (615) 738-8743
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019028829 | IL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dental Connnections | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dental Clinic/Center
- Freeport, IL
- NPI 1255463378
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1313020800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364428800000",
"number": "1942589643",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3122 W KUNKLE BLVD",
"address_2": "UNIT #4",
"city": "FREEPORT",
"state": "IL",
"postal_code": "61032",
"telephone_number": "615-738-8743",
"fax_number": "815-801-7652"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2661 W STEPHENSON ST",
"city": "FREEPORT",
"state": "IL",
"postal_code": "61032",
"telephone_number": "815-233-1215",
"fax_number": "815-801-7652"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUKARAKATE",
"first_name": "FADZANAI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-08-11",
"last_updated": "2013-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019028829",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Freeport, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.