Provider Demographics
NPI:1508018649
Name:ROBIN B BLAKKOLB DDS LTD
Entity Type:Organization
Organization Name:ROBIN B BLAKKOLB DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRANCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKKOLB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-964-5881
Mailing Address - Street 1:6800 MAIN ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-3493
Mailing Address - Country:US
Mailing Address - Phone:630-964-5880
Mailing Address - Fax:
Practice Address - Street 1:6800 MAIN ST
Practice Address - Street 2:SUITE 106
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-3493
Practice Address - Country:US
Practice Address - Phone:630-964-5880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL655020Medicare PIN