CHERRYVALE DENTAL CENTER LLC (NPI# 1669094041) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669094041 |
| Entity Type | Organization |
| Organization Name | CHERRYVALE DENTAL CENTER LLC |
| Practice Address |
1957 Pawlisch Dr Rockford IL 61112-1067 |
| Practice Telephone | 8153323477 |
| Practice Fax Number | 8153323470 |
| Mailing Telephone | 8153323477 |
| Mailing Fax Number | 8153323470 |
| Enumeration Date | 2020-05-08 |
| Last Update Date | 2020-05-08 |
| Authorized Official Name | BART PAUL (SOLE MEMBER) |
| Authorized Official Telephone | 8153323477 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
| Street Address |
1957 PAWLISCH DR |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61112-1067 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205972585 | Bart J. Paul | Dentist | 1957 Pawlisch Dr, Rockford, IL 61112-1067 | 2007-01-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215213475 | Matthew Caleb Beary | Physical Therapist | 1545 Temple Lane, Rockford, IL 61112 | 2011-11-01 |
| 1730469206 | Herman Chen | Pharmacist | 2206 Barnes Blvd, Rockford, IL 61112 | 2011-08-27 |
| 1598850273 | Charles W Matty | Dentist | 1855 Daimler Rd, Rockford, IL 61112 | 2006-10-04 |
| 1942317607 | James Edward Nijoka | Dentist | 1855 Daimler Road, Rockford, IL 61112 | 2006-08-25 |
| 1053366591 | Vincent R Facchiano | Optometrist | E265 Cherryvale Mall, Rockford, IL 61112 | 2006-05-23 |
| 1780616029 | Daniel Gordon Thorstenson | Chiropractor | 1877 Daimler Rd, Rockford, IL 61112-1005 | 2006-07-07 |
| 1760800221 | Brock Stephen Field | Chiropractor | 1877 Daimler Rd, Rockford, IL 61112-1005 | 2014-04-02 |
| 1629366489 | Craig Anthony Stear Jr. | Chiropractor | 1877 Daimler Rd, Rockford, IL 61112-1005 | 2011-07-14 |
| 1104931427 | Hulsebus Rockford Chiropractic | Chiropractor | 1877 Daimler Rd, Rockford, IL 61112-1005 | 2006-08-19 |
| 1215958970 | Michael John Hulsebus | Chiropractor | 1877 Daimler Rd, Rockford, IL 61112-1005 | 2006-07-21 |
| Find all providers in zip 61112 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841616661 | Ideal Dental Care PC | Clinic/Center | 5876 E State St, Rockford, IL 61108-2428 | 2014-03-18 |
| 1932666922 | Robert Busan Dds, Pllc | Clinic/Center | 4035 Morsay Dr Ste 1, Rockford, IL 61107-4875 | 2019-02-26 |
| 1730676990 | Alex Moore, Dmd PC | Clinic/Center | 6050 Brynwood Dr Ste 205, Rockford, IL 61114 | 2018-04-13 |
| 1689824898 | Corey J Brenner Dds Pllc | Clinic/Center | 9000 Walnut St, Box 236, Rockford, MN 55373-0236 | 2008-09-24 |
| 1639202914 | Thomas H. Moore Dds Ltd | Clinic/Center | 6075 Vantage Pl, Rockford, IL 61107-5905 | 2007-03-14 |
| 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 |
| 1740889344 | Nsp Dental LLC | Clinic/Center | 1900 Hollister Dr Ste 190, Libertyville, IL 60048-5283 | 2020-10-23 |
| 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 |
| Find all providers with the same taxonomy | ||||
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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.