GREAT LAKES DENTAL P.C. (NPI# 1447657234) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447657234 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES DENTAL P.C. |
| Other Organization Name | GREAT LAKES DENTAL SOLUTIONS |
| Practice Address |
1418 S Milwaukee Ave Suite 4 Libertyville IL 60048-3796 |
| Practice Telephone | 8152096272 |
| Enumeration Date | 2014-11-23 |
| Last Update Date | 2014-12-16 |
| Authorized Official Name | DR. ANSHUMAN SONI (PRESIDENT / DENTIST) |
| Authorized Official Telephone | 8152096272 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
019026289 | IL | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | NPI 1 | 1265415244 | 01 |
| IL | 9176879 | 05 |
| Other Name | Type Code |
|---|---|
| Great Lakes Dental Solutions | Doing Business As Name - Organization |
| Street Address |
1418 S MILWAUKEE AVE SUITE 4 |
| City | LIBERTYVILLE |
| State | IL |
| Zip Code | 60048-3796 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265415244 | Anshuman Soni | Dentist | 1418 S Milwaukee Ave, Suite # 4, Libertyville, IL 60048 | 2005-11-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184119950 | Park Avenue Dental Professionals, PC | Dentist | 1001 W. Park Avenue, Libertyville, IL 60048 | 2018-06-25 |
| 1437643525 | Shanna Coyle | Registered Nurse | 1128 Jaimee Ln, Libertyville, IL 60048 | 2018-06-21 |
| 1366943672 | Jackie Rayyan | Behavior Technician | 917 Sherwood Drive, Suite 201, Lake Bluff, IL 60048 | 2018-02-22 |
| 1851804850 | Mary E. Linsey | Counselor | 34180 Highway 45, Libertyville, IL 60048 | 2017-11-13 |
| 1962929018 | Affinity Integrated Healthcare | Chiropractor | 736 Florsheim Dr, St 12, Libertyville, IL 60048 | 2017-08-29 |
| 1164946471 | Christianna Patterson | Speech-Language Pathologist | 1870 W Winchester Rd #203, Libertyville, IL 60048 | 2017-07-28 |
| 1962938407 | Kyle Winiger | Specialist/Technologist | 4551 West Gavin Lane, Libertyville, IL 60048 | 2017-05-03 |
| 1396291530 | Karyn Kolner | Physical Therapist | 860 W Winchester Rd, #108, Libertyville, IL 60048 | 2016-08-28 |
| 1477900785 | Medlogic LLC | Clinic/Center | 114 West Rockland Road, Suite 201, Libertyville, IL 60048 | 2016-05-17 |
| 1477926343 | Robert Mcnulty | Student in an Organized Health Care Education/Training Program | 1313 Crane Blvd, Libertyville, IL 60048 | 2015-11-02 |
| Find all providers in zip 60048 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740889344 | Nsp Dental LLC | Clinic/Center | 1900 Hollister Dr Ste 190, Libertyville, IL 60048-5283 | 2020-10-23 |
| 1578952065 | Gerald | Clinic/Center | 1016 Michaels Ln, Libertyville, IL 60048-3715 | 2015-01-21 |
| 1982963419 | Ala Dean Attar Dmd PC | Clinic/Center | 712 Florsheim Dr Ste 12, Libertyville, IL 60048-5270 | 2012-05-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124629514 | Chicago Pediatric Dentistry and Orthodontics | Clinic/Center | 1136 S Delano Ct W Ste B202, Chicago, IL 60605-3734 | 2020-11-03 |
| 1437750031 | Secure Dental Xi | Clinic/Center | 1843 W Golf Rd, Schaumburg, IL 60194-1148 | 2020-11-02 |
| 1780283267 | Jenna Gaw, Dds, Pllc | Clinic/Center | 1724 Locust Pl Apt 303, Schaumburg, IL 60173-4239 | 2020-10-26 |
| 1285232827 | Paul Doodes Dds Phd PC | Clinic/Center | 45 S Park Blvd Ste 190, Glen Ellyn, IL 60137-6282 | 2020-10-15 |
| 1780290676 | Great Smile Dental Pllc | Clinic/Center | 720 Osterman Ave Ste 304, Deerfield, IL 60015-4339 | 2020-09-16 |
| 1669087375 | Naperville Smiles Dental | Clinic/Center | 8 W Gartner Rd Ste 124, Naperville, IL 60540-7549 | 2020-09-09 |
| 1649883364 | Mark J Maly Estate | Clinic/Center | 103 S Main St # Po, Orangeville, IL 61060-9244 | 2020-08-24 |
| 1760094718 | Stoffel and Tomazin Dental Associates, Ltd | Clinic/Center | 5718 W 35th St, Cicero, IL 60804-4222 | 2020-08-20 |
| 1215548771 | Meda Dental II LLC | Clinic/Center | 2735 Hassert Blvd Ste 159, Naperville, IL 60564-5205 | 2020-08-10 |
| 1033729090 | Thomas Lim Orthodontics Ltd | Clinic/Center | 1015 Waukegan Rd, Northbrook, IL 60062-3717 | 2020-08-05 |
| Find all providers with the same taxonomy | ||||
| City | LIBERTYVILLE |
| Zip Code | 60048 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.