Active NPI
Bruce Chisholm Bennett, D.D.S.
- Dentist
- Round Lake Beach, IL
National Provider Identifier
1669486049
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 15471
- Practice address
- 625 West Rollins Rd
Round Lake Beach, IL 60073 - Phone
- (847) 546-6644
- Fax
- (847) 546-6645
- NPI assigned
- Jul 28, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 15471 | IL | Primary |
Addresses
Primary practice location
625 West Rollins Rd
Round Lake Beach, IL 60073
Mailing address
1443 North Willow St
Lake Forest, IL 60045
Phone (847) 234-3014
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 |
|---|---|---|---|
| 15471 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1669486049",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1443 NORTH WILLOW ST",
"city": "LAKE FOREST",
"state": "IL",
"postal_code": "60045",
"telephone_number": "847-234-3014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "625 WEST ROLLINS RD",
"city": "ROUND LAKE BEACH",
"state": "IL",
"postal_code": "60073",
"telephone_number": "847-546-6644",
"fax_number": "847-546-6645"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "BRUCE",
"middle_name": "CHISHOLM",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "15471",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Round Lake Beach, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.