Provider Demographics
NPI:1023649829
Name:BLOCKI AND BASHFORD DENTAL, LLC
Entity type:Organization
Organization Name:BLOCKI AND BASHFORD DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GALE
Authorized Official - Last Name:BLOCKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-259-7560
Mailing Address - Street 1:200 E. EVERGREEN, SUITE 129
Mailing Address - Street 2:
Mailing Address - City:MT. PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056
Mailing Address - Country:US
Mailing Address - Phone:847-259-7560
Mailing Address - Fax:847-259-0808
Practice Address - Street 1:200 E. EVERGREEN, SUITE 129
Practice Address - Street 2:
Practice Address - City:MT. PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056
Practice Address - Country:US
Practice Address - Phone:847-259-7560
Practice Address - Fax:847-259-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty