Provider Demographics
NPI:1124185467
Name:PROCARE DENTAL GROUP, P.C.
Entity Type:Organization
Organization Name:PROCARE DENTAL GROUP, P.C.
Other - Org Name:GRAND DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:BRUNETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-640-1112
Mailing Address - Street 1:605 E ALGONQUIN RD
Mailing Address - Street 2:STE 300
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-4373
Mailing Address - Country:US
Mailing Address - Phone:847-640-1112
Mailing Address - Fax:847-640-1107
Practice Address - Street 1:5445 GRAND AVE
Practice Address - Street 2:STE 202
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-1725
Practice Address - Country:US
Practice Address - Phone:847-244-2775
Practice Address - Fax:847-244-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty