Provider Demographics
NPI:1669742649
Name:SENECA SMILES, LTD
Entity type:Organization
Organization Name:SENECA SMILES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/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:815-634-8009
Mailing Address - Street 1:293 S MAIN ST
Mailing Address - Street 2:P.O. BOX 289
Mailing Address - City:SENECA
Mailing Address - State:IL
Mailing Address - Zip Code:61360-9415
Mailing Address - Country:US
Mailing Address - Phone:815-357-1500
Mailing Address - Fax:815-357-1511
Practice Address - Street 1:293 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:IL
Practice Address - Zip Code:61360-9415
Practice Address - Country:US
Practice Address - Phone:815-357-1500
Practice Address - Fax:815-357-1511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190214931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty