Shandra Lolita Bundy-Smith, D.D.S.

Key facts

NPI

1184769739

Entity type

Individual (NPI type 1)

Primary specialty

General Practice Dentistry 1223G0001X

License

019023785 (IL)

Practice address

31 W 155TH St
Harvey, IL 60426-3556

Phone

(708) 596-5177

NPI assigned

Feb 21, 2007

Sex

Female

Sole proprietor

Yes

Organizations & group practices 1

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

• Dentist at Your Door LLC Dentist · Lynwood, IL · NPI 1487810685
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 13, 2021.

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626134400000",
    "number": "1184769739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19512 SEQUOIA AVE",
            "city": "LYNWOOD",
            "state": "IL",
            "postal_code": "604116825",
            "telephone_number": "708-288-6295",
            "fax_number": "708-889-1066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 W 155TH ST",
            "city": "HARVEY",
            "state": "IL",
            "postal_code": "604263556",
            "telephone_number": "708-596-5177"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "713 US Highway 41 Ste A",
            "address_purpose": "LOCATION",
            "city": "Schererville",
            "state": "IN",
            "postal_code": "463751798",
            "country_code": "US",
            "telephone_number": "219-293-8039",
            "fax_number": "913-752-9116",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUNDY-SMITH",
        "first_name": "SHANDRA",
        "middle_name": "LOLITA",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-21",
        "last_updated": "2021-07-13",
        "certification_date": "2021-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12013090A",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019023785",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Harvey, IL

• Tiara Lashay Brazill
• Deneen P. Brooks, MSW, LCSW, LSW, SWII
• Cary S Brown, MD
• Andrew D Bruggeman, MD
• Mickie S. Brunner, PHARMD,, R.PH
• Patricia A Burge, APN, FNP-BC
• William J. Burns, M.D.
• Jerome Howard Buster, D.O.
• Donne Bennett De Leon Caces, M.D., PH.D.
• Priscilla Ann Calcote, OTR/L

All providers in Harvey, IL · General Practice Dentistry in Illinois