Provider Demographics
NPI:1093291411
Name:PRO DENTAL CARE LTD
Entity Type:Organization
Organization Name:PRO DENTAL CARE LTD
Other - Org Name:BRAR DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-883-0200
Mailing Address - Street 1:1053 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:IL
Mailing Address - Zip Code:60118-3800
Mailing Address - Country:US
Mailing Address - Phone:847-836-8400
Mailing Address - Fax:
Practice Address - Street 1:1053 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:IL
Practice Address - Zip Code:60118
Practice Address - Country:US
Practice Address - Phone:847-836-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicaid