Provider Demographics
NPI:1295200921
Name:THE DENTAL MASTERS OF BELMONT, LLC
Entity Type:Organization
Organization Name:THE DENTAL MASTERS OF BELMONT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:NICS
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-791-3850
Mailing Address - Street 1:5236 W. BELMONT AVE.
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641
Mailing Address - Country:US
Mailing Address - Phone:773-725-7222
Mailing Address - Fax:773-725-2245
Practice Address - Street 1:5236 W. BELMONT AVE.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641
Practice Address - Country:US
Practice Address - Phone:773-725-7222
Practice Address - Fax:773-725-2245
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE DENTAL MASTERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty