Access Dental of Bloomington PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

ACCESS DENTAL OF BLOOMINGTON PLLC

Practice address

401 N Veterans Pkwy Ste 4
Bloomington, IL 61704-7716

Phone

(469) 444-2818

NPI assigned

Dec 9, 2021

Last updated

Dec 9, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Andrea Carrillo

Title

Regional Director

Phone

(512) 351-2612

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639008000000",
    "number": "1073272886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8150 SPRINGWOOD DR # 150B",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750635810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 N VETERANS PKWY STE 4",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617047716",
            "telephone_number": "469-444-2818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACCESS DENTAL OF BLOOMINGTON PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-09",
        "last_updated": "2021-12-09",
        "certification_date": "2021-12-09",
        "status": "A",
        "authorized_official_last_name": "CARRILLO",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "REGIONAL DIRECTOR",
        "authorized_official_telephone_number": "512-351-2612"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Bloomington, IL
• Providers in Bloomington, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.