Active NPI
Bamini Blau
- Pediatric Dentistry
- Bartlett, IL
National Provider Identifier
1376797399
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 021002113
- Practice address
- 774 W Bartlett Rd
Bartlett, IL 60103-4482 - Phone
- (630) 213-3636
- Fax
- (630) 213-3633
- NPI assigned
- Nov 5, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 021002113 | IL | Primary |
Addresses
Primary practice location
774 W Bartlett Rd
Bartlett, IL 60103-4482
Mailing address
774 W Bartlett Rd
Bartlett, IL 60103-4482
Phone (630) 213-3636
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021002113 | IL | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gentlecare for Kids Teeth | Pediatric Dentistry | Past | Accepting new patients |
Interoperability endpoints
- bblau291174@direct.myadvocateaurora.org
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatric Dentistry
- Bartlett, IL
- NPI 1982754123
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225843200000",
"number": "1376797399",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "774 W BARTLETT RD",
"city": "BARTLETT",
"state": "IL",
"postal_code": "601034482",
"telephone_number": "630-213-3636",
"fax_number": "630-213-3633"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "774 W BARTLETT RD",
"city": "BARTLETT",
"state": "IL",
"postal_code": "601034482",
"telephone_number": "630-213-3636",
"fax_number": "630-213-3633"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAU",
"first_name": "BAMINI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-11-05",
"last_updated": "2008-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "IL",
"license": "021002113",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bartlett, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.