LLCDENTAL, (NPI# 1669924833) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669924833 |
| Entity Type | Organization |
| Organization Name | LLCDENTAL, |
| Practice Address |
3494 Vollmer Rd Olympia Fields IL 60461-1018 |
| Practice Telephone | 7087472273 |
| Practice Fax Number | 7087472238 |
| Mailing Telephone | 7087472273 |
| Mailing Fax Number | 7087472238 |
| Enumeration Date | 2016-11-03 |
| Last Update Date | 2016-11-03 |
| Authorized Official Name | MR. KEVIN DALE MIMMS (MANAGER) |
| Authorized Official Telephone | 7087472273 |
| Authorized Official Credential | M.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | 019020348 | IL | Dental Providers |
| Street Address |
3494 VOLLMER RD |
| City | OLYMPIA FIELDS |
| State | IL |
| Zip Code | 60461-1018 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609372564 | Katherine Gill Haddad | Student in an Organized Health Care Education/Training Program | 20201 S. Crawford Avenue, Attn: Postdoctoral Education, Olympia Fields, IL 60461 | 2018-03-31 |
| 1750886610 | Kim Minh Dang | Student in an Organized Health Care Education/Training Program | 20201 South Crawford, Olympia Fields, IL 60461 | 2018-03-23 |
| 1619484110 | Alexandra N. Douvas | Dentist | 20180 Governors Hwy, Ste 104, Olympia Fields, IL 60461 | 2018-01-05 |
| 1992258438 | Krystyne Doty | Nurse Practitioner | 3800 W 203rd St Ste 209, Olympia Fields, IL 60461 | 2016-08-02 |
| 1205286747 | Shirlene Umali | Registered Nurse | 20201 South Crawford Ave, Olympia Fields, IL 60461 | 2016-06-15 |
| 1386002590 | Touch of Wholeness Psychological Services, LLC | Psychologist | 20280 Governors Dr, Suite 207, Olympia Fields, IL 60461 | 2016-02-02 |
| 1063895357 | David Dardick | Dentist | 20180 Governors Hwy Ste 104, Olympia Fields, IL 60461 | 2015-07-04 |
| 1811378623 | Fins Healthcare Agency | Nursing Care | 3612 Lincohn Highway, Suite 19, Olympia Fields, IL 60461 | 2015-06-17 |
| 1285048959 | Garud Ranga Raj | Orthopaedic Surgery | 20817 Alexander St, Olympia Fields, IL 60461 | 2014-06-20 |
| 1811316334 | Brett Hapeman | Emergency Medicine | 20201 S Crawford, Attn: Postdoctoral Education, Olympia Fields, IL 60461 | 2014-04-11 |
| Find all providers in zip 60461 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619484110 | Alexandra N. Douvas | Dentist | 20180 Governors Hwy, Ste 104, Olympia Fields, IL 60461 | 2018-01-05 |
| 1245418938 | Lawrence Anthony White | Dentist | 612 Brookwood Dr, Olympia Fields, IL 60461-1508 | 2008-02-05 |
| 1790904290 | Andrew J Wang | Dentist | 3612 Lincoln Hwy Ste 18, Olympia Fields, IL 60461-1637 | 2007-04-24 |
| 1326136458 | Vincent Au Oganwu | Dentist | 2520f West Lincoln Highway, Olympia Fields, IL 60461 | 2006-10-11 |
| 1245261577 | James H Camino Dds Ltd | Dentist | 2555 W Lincoln Hwy, Ste 107, Olympia Fields, IL 60461-1938 | 2006-07-05 |
| 1306241922 | Neil P. Parikh D.d.s., P.c | Dentist | 2555 Lincoln Hwy, Suite 107, Olympia Fields, IL 60461-1936 | 2014-10-24 |
| 1023359510 | Marylyn Jackson | Dentist | 2555 Lincoln Hwy, Suite 113, Olympia Fields, IL 60461-1936 | 2013-03-07 |
| 1003070798 | Roshan P Parikh | Dentist | 2555 Lincoln Hwy, Suite 107, Olympia Fields, IL 60461-1936 | 2008-07-11 |
| 1528248598 | Anthony Nicholas Miceli | Dentist | 20180 Governors Hwy, Ste 104, Olympia Fields, IL 60461 | 2007-11-07 |
| 1639235690 | Alexandra N Douvas | Dentist | 20180 Governors Hwy, Suite #104, Olympia Fields, IL 60461 | 2006-12-27 |
| Find all providers in OLYMPIA FIELDS | ||||
| City | OLYMPIA FIELDS |
| Zip Code | 60461 |
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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.