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General NPI Number Information
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NPI Number | 1528246212
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Entity Type | Organization
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Legal Business Name | PROCARE DENTAL GROUP, P.C.
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 08/27/2013
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Provider Practice Location Address
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Address Line | 434 WEST ONTARIO STREET STE 300
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City | CHICAGO
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State | IL
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Zip | 60654
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Country | US
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Telephone | 847-640-1112
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Fax | 847-640-1107
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Provider Business Mailing Address
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Address Line | 434 W ONTARIO ST STE 300
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City | CHICAGO
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State | IL
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Zip | 60654
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Country | US
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Telephone | 312-475-9751
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Fax | 312-475-9754
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Authorized Official
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Title or Position | CEO
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Name | DR. ROBERT G BRUNETTI
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Credential | DDS
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Telephone | 847-640-1112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 060-008822
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License Number State | IL
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