Park City Dental, Pc

LBN: Park City Dental, Pc
Park City Dental, Pc is an health care organization with primary practice located at 555 N Court St Suite 100, Rockford IL 61103-6862. The organization recently has only one registered license in Dental Providers / Dentist, which is considered as the primary health care specialty. Park City Dental, Pc can be contacted via phone (815) 708-6556, or through Grinter, Jason M via phone (815) 708-6556.

Contact Information

Primary practice address
555 N Court St Suite 100 Rockford IL 61103-6862
Phone: (815) 708-6556
Fax: (815) 708-6477
Website:
Map and Directions
Authorized official contact:
Name: Grinter, Jason M Doctor of Dental Surgery (DDS)
Phone: (815) 708-6556

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 019026609 Illinois

Profile Details

NPI number 1225469596
LBN Legal business name Park City Dental, Pc
DBA Doing business as
Authorized official Grinter, Jason M Doctor of Dental Surgery (DDS)
Entity Organization
Organization subpart 1 No
Enumeration date Dec 11th, 2013
Last updated Dec 11th, 2013 - about 12 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1225469596 NPPES
Illinois MEDICAID 091906609

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