The Dental Mastrs of Ravenswood LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

THE DENTAL MASTRS OF RAVENSWOOD LLC

Doing business as

Albany Park Dental

Practice address

1945 W. Wilson, Ste # 5117
Chicago, IL 60640

Phone

(773) 588-7840

NPI assigned

Apr 3, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Eric N. Bloom, DDS

Title

Partner

Phone

(847) 791-3850

Specialties & licenses 1

Addresses

Other names 1

• Albany Park Dental Doing business as

Locations

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

{
    "created_epoch": "1491177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491177600000",
    "number": "1588196083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1945 W. WILSON, STE # 5117",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60640",
            "telephone_number": "773-588-7840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1945 W. WILSON, STE # 5117",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60640",
            "telephone_number": "773-588-7840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DENTAL MASTRS OF RAVENSWOOD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-03",
        "last_updated": "2017-04-03",
        "status": "A",
        "authorized_official_last_name": "BLOOM",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "PARTNER",
        "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": [
        {
            "organization_name": "Albany Park Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Chicago, IL
• Providers in Chicago, IL by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2017; 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.