Russel Lee Skyles, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019.014985 Issued in IL

Practice address

200 E Evergreen Ave
Suite 129
Mt Prospect, IL 60056-3240

Phone

(847) 259-7560

Fax

(847) 259-0808

NPI assigned

Jul 18, 2008

Sex

Male

Sole proprietor

Yes

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)

Not enrolled

State licenses

Practice roles

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.

• Blocki and Bashford Dental, LLC

  • General Practice Dentistry
  • Mt. Prospect, IL
  • NPI 1023649829
  NPD (past)

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

{
    "created_epoch": "1216339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216339200000",
    "number": "1871757807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E EVERGREEN AVE",
            "address_2": "SUITE 129",
            "city": "MT PROSPECT",
            "state": "IL",
            "postal_code": "600563240",
            "telephone_number": "847-259-7560",
            "fax_number": "847-259-0808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E EVERGREEN AVE",
            "address_2": "SUITE 129",
            "city": "MT PROSPECT",
            "state": "IL",
            "postal_code": "600563240",
            "telephone_number": "847-259-7560",
            "fax_number": "847-259-0808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKYLES",
        "first_name": "RUSSEL",
        "middle_name": "LEE",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-18",
        "last_updated": "2008-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.014985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gurmukh Singh, PA-C
• Sukhwinder K Singh, LSW
• Evans R Sirois, D.O
• SK Supplies Inc
• Sogi Skariah, RN
• Smile Pain & Rehab Inc
• Larekia Smith
• Sally Smith
• Tima F. Smith, PSYD
• Alexandra Smolina

• General Practice Dentistry in Mt Prospect, IL
• Providers in Mt Prospect, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 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.