NPIMap

Organization Active NPI

Dental Partners of Woodridge LLC

  • Dental Clinic/Center
  • Woodridge, IL
National Provider Identifier
1285144493
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
019.026417 Issued in IL
Legal business name
DENTAL PARTNERS OF WOODRIDGE LLC
Practice address
2309 63Rd St
Woodridge, IL 60517-1300
Phone
(630) 869-0063
Fax
(630) 296-8966
NPI assigned
Oct 3, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Jacqueline Blasko, DMD
Title
Dentist/Partner
Phone
(630) 869-0063

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 019.026417 IL Primary

Addresses

Primary practice location

2309 63Rd St
Woodridge, IL 60517-1300

Mailing address

2309 63Rd St
Woodridge, IL 60517-1300
Phone (630) 869-0063

Other names 1

  • 4 Star Dental Doing business as

National Provider Directory

National Provider Directory

Locations

2309 63rd St
Woodridge, IL 60517
Phone (630) 869-0063

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": "1506988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1285144493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2309 63RD ST",
            "city": "WOODRIDGE",
            "state": "IL",
            "postal_code": "605171300",
            "telephone_number": "630-869-0063",
            "fax_number": "630-296-8966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2309 63RD ST",
            "city": "WOODRIDGE",
            "state": "IL",
            "postal_code": "605171300",
            "telephone_number": "630-869-0063",
            "fax_number": "630-296-8966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PARTNERS OF WOODRIDGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-03",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BLASKO",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "DENTIST/PARTNER",
        "authorized_official_telephone_number": "630-869-0063",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": "019.026417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "4 Star Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodridge, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.