Mobile Dental Care of Illinois PC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

MOBILE DENTAL CARE OF ILLINOIS PC

Practice address

3716 217TH St
Matteson, IL 60443-3703

Phone

(773) 329-4450

NPI assigned

Apr 26, 2011

Organization subpart

No

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

Authorized official

Name

Mr. Frank Charles Camarda Jr.

Title

Manager

Phone

(708) 744-9188

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1303776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404086400000",
    "number": "1962793943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 S RIVERSIDE PLZ",
            "address_2": "19 EAST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606063728",
            "telephone_number": "773-329-4450",
            "fax_number": "773-329-4454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3716 217TH ST",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604433703",
            "telephone_number": "773-329-4450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE DENTAL CARE OF ILLINOIS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-26",
        "last_updated": "2014-06-30",
        "status": "A",
        "authorized_official_last_name": "CAMARDA",
        "authorized_official_first_name": "FRANK",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "708-744-9188",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Matteson, IL
• Providers in Matteson, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2014; 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.