Provider Demographics
NPI:1750409306
Name:PROCARE DENTAL GROUP P.C.
Entity type:Organization
Organization Name:PROCARE DENTAL GROUP P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:5950 W PARK AVE
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-3855
Practice Address - Country:US
Practice Address - Phone:708-652-3540
Practice Address - Fax:708-652-3541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty