Provider Demographics
NPI:1861607798
Name:PLAINFIELD FAMILY DENTAL CENTER
Entity type:Organization
Organization Name:PLAINFIELD FAMILY DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:PULLARA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-436-1000
Mailing Address - Street 1:24204 W LOCKPORT ST
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-2902
Mailing Address - Country:US
Mailing Address - Phone:815-436-1000
Mailing Address - Fax:815-436-1464
Practice Address - Street 1:24204 W LOCKPORT ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-2902
Practice Address - Country:US
Practice Address - Phone:815-436-1000
Practice Address - Fax:815-436-1464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190214931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty