NPIMap

Organization Active NPI

Bull Valley Aesthetic Dentistry

  • Dentist
  • McHenry, IL
National Provider Identifier
1962839001
Registry record updated Oct 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019020769 Issued in IL
Legal business name
BULL VALLEY AESTHETIC DENTISTRY
Practice address
601 Ridgeview Dr
McHenry, IL 60050-7010
Phone
(815) 344-2264
NPI assigned
Oct 3, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2013

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

Authorized official

Name
Christine Dano
Title
Business Manager
Phone
(815) 344-2264

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 019020769 IL Primary

Addresses

Primary practice location

601 Ridgeview Dr
McHenry, IL 60050-7010

Mailing address

601 Ridgeview Dr
McHenry, IL 60050-7010

National Provider Directory

National Provider Directory

Locations

601 Ridgeview Dr
McHenry, IL 60050
Phone (815) 344-2264

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1380758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380758400000",
    "number": "1962839001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 RIDGEVIEW DR",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600507010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 RIDGEVIEW DR",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600507010",
            "telephone_number": "815-344-2264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BULL VALLEY AESTHETIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-03",
        "last_updated": "2013-10-03",
        "status": "A",
        "authorized_official_last_name": "DANO",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "815-344-2264"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019020769",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McHenry, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2013; 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.