Sara Elisabeth Day, DMD
Individual provider Active NPI Dentist · Bradley, IL
NPI 1194078261 · NPPES record last updated Oct 16, 2021
Key facts
- NPI
- 1194078261
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 019029215 (IL)
- Practice address
- 840 N Kinzie Ave Ste E
Bradley, IL 60915-1231 - Phone
- (815) 401-9535
- NPI assigned
- Oct 26, 2012
- Sex
- Female
- Sole proprietor
- No
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
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151215002646 | IL | Order and Referring Only - Oral Surgery |
8022319177 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019029215 | IL | MD | Dentist |
| D10438 | OR | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D10438 | OR | |
| Dentist | 122300000X | 019029215 | IL | Yes |
Addresses
Primary practice location
840 N Kinzie Ave Ste E
Bradley, IL 60915-1231
Mailing address
840 N Kinzie Ave Ste E
Bradley, IL 60915-1231
Phone (815) 401-9535
Other providers in Bradley, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 16, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.