Active NPI
Diane Marie Brandlein, DDS
- General Practice Dentistry
- South Beloit, IL
National Provider Identifier
1861652919
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019019357
- Practice address
- 1917 Blackhawk Blvd
South Beloit, IL 61080 - Phone
- (815) 389-3605
- NPI assigned
- Jun 12, 2008
- Last updated
- Jun 12, 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019019357 | IL | Primary |
Addresses
Primary practice location
1917 Blackhawk Blvd
South Beloit, IL 61080
Mailing address
1917 Blackhawk Blvd
South Beloit, IL 61080
Phone (815) 389-3605
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 |
|---|---|---|---|
| 019019357 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213228800000",
"number": "1861652919",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1917 BLACKHAWK BLVD",
"city": "SOUTH BELOIT",
"state": "IL",
"postal_code": "61080",
"telephone_number": "815-389-3605"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1917 BLACKHAWK BLVD",
"city": "SOUTH BELOIT",
"state": "IL",
"postal_code": "61080",
"telephone_number": "815-389-3605"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRANDLEIN",
"first_name": "DIANE",
"middle_name": "MARIE",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-06-12",
"last_updated": "2008-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019019357",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Beloit, IL
- Jennifer Marie Auge, CSFA
- Beloit Clinic, S.C.
- Beloit Health System, Inc (South Beloit Clinic - BHS)
- Board of Trustees of the University of Illinois (University Clinic at South Beloit School District)
- Barbara Ann Bressler, DT
- Daniel Bressler, MT-BC
- James Earl Brooks I, M.S
- Denise C Burton, RN
- City of South Beloit (South Beloit Fire Department)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 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.