Mackenzie L Brindley, DMD
Individual provider Active NPI Dentist · Lake Bluff, IL
NPI 1982227799 · NPPES record last updated Aug 24, 2023
Key facts
- NPI
- 1982227799
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 019.034251 (IL)
- Practice address
- 101 N Waukegan Rd Ste 1200
Lake Bluff, IL 60044-1686 - Phone
- (847) 243-4405
- NPI assigned
- May 27, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.034251 | IL | MD | Dentist |
| 10435 | KY | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 10435 | KY | |
| Dentist | 122300000X | 019.034251 | IL | Yes |
Addresses
Primary practice location
101 N Waukegan Rd Ste 1200
Lake Bluff, IL 60044-1686
Mailing address
101 N Waukegan Rd Ste 1200
Lake Bluff, IL 60044-1686
Phone (847) 234-4405
Other providers in Lake Bluff, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 24, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.