Mark Burgess, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

19020667 Issued in IL

Practice address

2103 E Washington St Ste 4B
Bloomington, IL 61701-4362

Phone

(309) 663-6564

NPI assigned

Nov 9, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Solo Dental Group PLLC

  dba Solo Dental

  • General Practice Dentistry
  • Bloomington, IL
  • NPI 1689562373
  NPD (past)

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1154492593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2103 E WASHINGTON ST STE 4B",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617014362",
            "telephone_number": "309-663-6564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2103 E WASHINGTON ST STE 4B",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617014362",
            "telephone_number": "309-663-6564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGESS",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "19020667",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William G Brunner, M.S., L.C.P.C.
• Kaya Buchanan, RDN
• Rachel Buchler
• Patricia A Buckley, P.T.
• Kylee Burcham, COTA
• Jeffrey A. Burk
• Molly Burke, MSW, LCSW
• Nicholas Christopher Burke, PT
• Deanne Marie Burnett, SURGICAL ASSISTANT
• Caitlyn Lee Burton-Gowler

• 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 Jul 8, 2007; 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.