BROADWAY FAMILY DENTAL CENTER (NPI# 1922378900) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922378900 |
| Entity Type | Organization |
| Organization Name | BROADWAY FAMILY DENTAL CENTER |
| Practice Address |
595 N Broadway St Coal City IL 60416-1046 |
| Practice Telephone | 8156348009 |
| Practice Fax Number | 8156342008 |
| Mailing Telephone | 8156348009 |
| Mailing Fax Number | 8156342008 |
| Enumeration Date | 2012-01-06 |
| Last Update Date | 2012-01-06 |
| Authorized Official Name | DR. PETER J PULLARA JR. (DENTIST/OWNER) |
| Authorized Official Telephone | 8156348009 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
019021493 | IL | Dental Providers |
| Street Address |
595 N BROADWAY ST |
| City | COAL CITY |
| State | IL |
| Zip Code | 60416-1046 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821201575 | Pullara Family Dental Center | Dentist | 595 N Broadway St, Coal City, IL 60416-1046 | 2007-05-08 |
| 1669029245 | Kristin Marie Vaught | Dentist | 595 N Broadway St, Coal City, IL 60416-1046 | 2019-08-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245759083 | Jenna Valentine | Counselor | 40 N Broadway Street, Coal City, IL 60416 | 2017-09-13 |
| 1518042688 | Highland Park Cvs, L.L.C. | Durable Medical Equipment & Medical Supplies | 245 S Broadway Street, Coal City, IL 60416 | 2006-10-26 |
| 1912919259 | Daniel Martin Jurak | Family Medicine | 935 E Division St, Diamond, IL 60416 | 2006-08-13 |
| 1538653894 | Natalie A Palka | Nurse Practitioner | 5775 E State Route 113, Coal City, IL 60416 | 2018-06-20 |
| 1437235447 | Highland Park Cvs, L.L.C. | Durable Medical Equipment & Medical Supplies | 245 S Broadway Street, Coal City, IL 60416 | 2006-10-31 |
| 1144745100 | Amanda Patten | Speech-Language Pathologist | 300 N Broadway St, Coal City, IL 60416-1043 | 2017-08-10 |
| 1467487975 | Roman M Smyk | Surgery | 460 N Broadway St, Coal City, IL 60416-1045 | 2006-07-12 |
| 1144471772 | Spyro D. Analytis, Mdpc | Internal Medicine | 460 N Broadway St, Coal City, IL 60416-1045 | 2008-10-01 |
| 1487729430 | John D Scala Md PC | Pediatrics | 460 N Broadway St, Coal City, IL 60416-1045 | 2006-11-22 |
| 1487948964 | Liberty Medical Center Coal City Sc | Family Medicine | 4 E North St, Coal City, IL 60416-1087 | 2011-06-02 |
| Find all providers in zip 60416 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821201575 | Pullara Family Dental Center | Dentist | 595 N Broadway St, Coal City, IL 60416-1046 | 2007-05-08 |
| 1962620088 | Robin Trevison | Dentist | 645 E Division St, Coal City, IL 60416-1679 | 2007-04-23 |
| 1356604672 | Coal City Dental Center | Dentist | 645 E Division St, Coal City, IL 60416-1679 | 2012-06-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104425230 | Sundeep Franklin Dmd & Daiana Capota Dmd Pllc | Dentist | 320 N Mclean Blvd Ste B, Elgin, IL 60123-3220 | 2020-10-20 |
| 1801403555 | Stephanie Elizabeth Miller | Dentist | 2220 Sisters Ave, Naperville, IL 60564-4394 | 2020-09-27 |
| 1417564121 | Gursimran Reen, Dmd LLC | Dentist | 29 S Webster St Ste 108, Naperville, IL 60540-5353 | 2020-09-26 |
| 1285240531 | Summit Dental Center LLC | Dentist | 7710 W 62nd Pl, Summit, IL 60501-1702 | 2020-09-22 |
| 1295340628 | Karina Valentin | Dentist | 1534 N Oakley Blvd Apt 3f, Chicago, IL 60622-1783 | 2020-09-11 |
| 1932713583 | Kevin G Reardon | Dentist | 479 S Spring Rd, Elmhurst, IL 60126-3857 | 2020-09-01 |
| 1831702307 | Sms Dental LLC | Dentist | 17727 Halsted St, Homewood, IL 60430 | 2020-08-25 |
| 1548870884 | Daniel Patrick Jurgens | Dentist | 2 N Country Club Rd Ste 2, Decatur, IL 62521-4174 | 2020-08-02 |
| 1184233934 | Shawna Jade Dudovitz | Dentist | 309 Tamarack Ln, Shiloh, IL 62269-2993 | 2020-07-28 |
| 1417565748 | Robert Hails | Dentist | 3540 N Belt W Ste B, Belleville, IL 62226-5975 | 2020-07-22 |
| 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.