NPIMap

Organization Active NPI

Russell J Bak DDS PC

  • General Practice Dentistry
  • Bolingbrook, IL
National Provider Identifier
1225108665
Registry record updated Apr 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
19-024912 Issued in IL
Legal business name
RUSSELL J BAK DDS PC
Practice address
433 N Bolingbrook Dr
Suite 1
Bolingbrook, IL 60440
Phone
(630) 759-4191
Fax
(630) 759-4378
NPI assigned
Nov 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2019

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

Authorized official

Name
Dr. Russell J Bak, DDSNPI 1659441301
Title
Owner
Phone
(630) 759-4191

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 19-024912 IL Primary

Addresses

Primary practice location

433 N Bolingbrook Dr
Suite 1
Bolingbrook, IL 60440

Mailing address

433 N Bolingbrook Dr
Suite 1
Bolingbrook, IL 60440
Phone (630) 759-4191

National Provider Directory

National Provider Directory

Locations

433 N Bolingbrook Dr
Ste 1
Bolingbrook, IL 60440
Phone (630) 759-4191

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556236800000",
    "number": "1225108665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "433 N BOLINGBROOK DR",
            "address_2": "SUITE 1",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "60440",
            "telephone_number": "630-759-4191",
            "fax_number": "630-759-4378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 N BOLINGBROOK DR",
            "address_2": "SUITE 1",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "60440",
            "telephone_number": "630-759-4191",
            "fax_number": "630-759-4378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSSELL J BAK DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2019-04-26",
        "status": "A",
        "authorized_official_last_name": "BAK",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-759-4191",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "19-024912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bolingbrook, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2019; 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.