The Dental Masters of Belmont, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

THE DENTAL MASTERS OF BELMONT, LLC

Practice address

5236 W. Belmont Ave.
Chicago, IL 60641

Phone

(773) 725-7222

Fax

(773) 725-2245

NPI assigned

Oct 9, 2018

Organization subpart

Yes

Parent organization

THE DENTAL MASTERS, LLCAs reported in NPPES

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

Authorized official

Name

Dr. Eric Nics Bloom, DDS

Title

Manager

Phone

(847) 791-3850

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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

• Jerome J Gomolka, DDS

  • General Practice Dentistry
  • Chicago, IL
  • NPI 1437382843
  NPD (past)
• Jerome Michael Kadleck, DDS

  • General Practice Dentistry
  • Chicago, IL
  • NPI 1538209424
  NPD (past)

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

{
    "created_epoch": "1539043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539043200000",
    "number": "1295200921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5236 W. BELMONT AVE.",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60641",
            "telephone_number": "773-725-7222",
            "fax_number": "773-725-2245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5236 W. BELMONT AVE.",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60641",
            "telephone_number": "773-725-7222",
            "fax_number": "773-725-2245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DENTAL MASTERS OF BELMONT, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE DENTAL MASTERS, LLC",
        "enumeration_date": "2018-10-09",
        "last_updated": "2018-10-09",
        "status": "A",
        "authorized_official_last_name": "BLOOM",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "NICS",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "847-791-3850",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Chicago, IL
• Providers in Chicago, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2018; 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.