Provider Demographics
NPI:1366970295
Name:BB DENTAL CARE
Entity type:Organization
Organization Name:BB DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:815-633-9864
Mailing Address - Street 1:8100 FOREST HILLS ROAD
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111
Mailing Address - Country:US
Mailing Address - Phone:815-633-9864
Mailing Address - Fax:
Practice Address - Street 1:115 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-3231
Practice Address - Country:US
Practice Address - Phone:815-547-2721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-23
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019016241122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty