NPIMap

Organization Active NPI

MLB Dental, LTD.

  • Dentist
  • Forest Park, IL
National Provider Identifier
1366731580
Registry record updated Mar 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019.027066 Issued in IL
Legal business name
MLB DENTAL, LTD.
Practice address
333 Circle Ave
Forest Park, IL 60130-3624
Phone
(708) 771-0330
Fax
(708) 771-4076
NPI assigned
Mar 29, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2011

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

Authorized official

Name
Dr. Marlene Lynn Beeson, DDS
Title
Owner/President
Phone
(630) 915-9510

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 019.027066 IL Primary

Addresses

Primary practice location

333 Circle Ave
Forest Park, IL 60130-3624

Mailing address

333 Circle Ave
Forest Park, IL 60130-3624
Phone (708) 771-0330

Other names 1

  • Platinum Dental Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
MLB Dental LTD2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1301356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301356800000",
    "number": "1366731580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 CIRCLE AVE",
            "city": "FOREST PARK",
            "state": "IL",
            "postal_code": "601303624",
            "telephone_number": "708-771-0330",
            "fax_number": "708-771-4076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 CIRCLE AVE",
            "city": "FOREST PARK",
            "state": "IL",
            "postal_code": "601303624",
            "telephone_number": "708-771-0330",
            "fax_number": "708-771-4076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MLB DENTAL, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-29",
        "last_updated": "2011-03-29",
        "status": "A",
        "authorized_official_last_name": "BEESON",
        "authorized_official_first_name": "MARLENE",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "630-915-9510",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.027066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Platinum Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Forest Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2011; 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.