Brooke Middendorf, CDA
Individual provider Active NPI Dental Assistant · Clarendon Hills, IL
NPI 1346839263 · NPPES record last updated Jan 14, 2021
Key facts
- NPI
- 1346839263
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dental Assistant 126800000X
- License
- 1179030 (IL)
- Practice address
- 433 Ogden Ave
Clarendon Hills, IL 60514-2814 - Phone
- (630) 320-8888
- NPI assigned
- Jan 14, 2021
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1179030 | IL | MD | Dental Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Band & Wire Orthodontics, LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Assistant | 126800000X | 1179030 | IL | Yes |
Addresses
Primary practice location
433 Ogden Ave
Clarendon Hills, IL 60514-2814
Mailing address
433 Ogden Ave
Clarendon Hills, IL 60514-2814
Phone (630) 320-8888
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | info@bandandwire.com | Direct |
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All providers in Clarendon Hills, IL · Dental Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 14, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.