Provider Demographics
NPI:1629178520
Name:JEFF A BLEILE DDS PC
Entity Type:Organization
Organization Name:JEFF A BLEILE DDS PC
Other - Org Name:HIGHLAND PARK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:BLEILE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-432-4131
Mailing Address - Street 1:806 CENTRAL AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035
Mailing Address - Country:US
Mailing Address - Phone:847-432-4131
Mailing Address - Fax:847-432-2707
Practice Address - Street 1:806 CENTRAL AVE
Practice Address - Street 2:STE 201
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035
Practice Address - Country:US
Practice Address - Phone:847-432-4131
Practice Address - Fax:847-432-2707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty