Robin Brent Blakkolb, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

021-001127 Issued in IL

Practice address

6800 Main St
Suite 106
Downers Grove, IL 60516-3493

Phone

(630) 964-5880

NPI assigned

Nov 2, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208908800000",
    "number": "1508945437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6800 MAIN ST",
            "address_2": "SUITE 106",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605163493",
            "telephone_number": "630-964-5880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6800 MAIN ST",
            "address_2": "SUITE 106",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605163493",
            "telephone_number": "630-964-5880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKKOLB",
        "first_name": "ROBIN",
        "middle_name": "BRENT",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-02",
        "last_updated": "2008-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "021-001127",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Casey Birkel, D.V.M
• April L Bitner, PHARMD
• Kate Blackburn
• Bradford Blakeman, MD
• Courtney M. Blakemore
• Heather Blanck
• Thomas Edward Blaney, DPM
• Joan M Blasingame, SLP
• Halina E Blaszynski, MOTR L
• John F Blattner, PHD

• Oral and Maxillofacial Surgery (Dentist) in Downers Grove, IL
• Providers in Downers Grove, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 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.

Verify at the official NPI Registry.