Daniel T Bodine DDS PC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

DANIEL T BODINE DDS PC

Practice address

11130 South Harlem Ave
Worth, IL 60482

Phone

(708) 448-6760

Fax

(708) 448-8869

NPI assigned

Nov 1, 2006

Last updated

Aug 22, 2020By 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

Dr. Daniel Thomas Bodine, DDS

Title

President

Phone

(708) 448-6760

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164500534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11130 SOUTH HARLEM AVE",
            "city": "WORTH",
            "state": "IL",
            "postal_code": "60482",
            "telephone_number": "708-448-6760",
            "fax_number": "708-448-8869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11130 SOUTH HARLEM AVE",
            "city": "WORTH",
            "state": "IL",
            "postal_code": "60482",
            "telephone_number": "708-448-6760",
            "fax_number": "708-448-8869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DANIEL T BODINE DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BODINE",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-448-6760",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.