Dentist in Bloomingdale LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DENTIST IN BLOOMINGDALE LLC

Practice address

366 W Army Trail Rd Ste 310a
Bloomingdale, IL 60108-5602

Phone

(803) 830-6881

NPI assigned

Nov 13, 2024

Organization subpart

No

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

Authorized official

Name

Mr. Sunil Reddy Eamani

Title

Manager

Phone

(803) 830-6881

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1731456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731456000000",
    "number": "1093539363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "366 W ARMY TRAIL RD STE 310A",
            "city": "BLOOMINGDALE",
            "state": "IL",
            "postal_code": "601085602",
            "telephone_number": "803-830-6881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "366 W ARMY TRAIL RD STE 310A",
            "city": "BLOOMINGDALE",
            "state": "IL",
            "postal_code": "601085602",
            "telephone_number": "803-830-6881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTIST IN BLOOMINGDALE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-13",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-13",
        "status": "A",
        "authorized_official_last_name": "EAMANI",
        "authorized_official_first_name": "SUNIL",
        "authorized_official_middle_name": "REDDY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "803-830-6881",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amela I Dedic, PA-C
• Christine Dellas, APN
• Stephen Henry Demari, HIS
• Andrea Jacqueline Demola, MOT, OTR/L
• Dental Professionals of Illinois, P.C.
• Avani Desai, PT
• Anupama Deshpande, MD
• Distinctive Dental Care of Bloomingdale
• Distinctive Dental PC
• Ammar Y Divan, MD

• General Practice Dentistry in Bloomingdale, IL
• Providers in Bloomingdale, 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 Nov 13, 2024; 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.