Provider Demographics
NPI:1891041331
Name:BARDELL, JANET CHRISTINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:CHRISTINE
Last Name:BARDELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 E OAKLAND AVE
Mailing Address - Street 2:STE. D
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-5758
Mailing Address - Country:US
Mailing Address - Phone:309-663-6564
Mailing Address - Fax:
Practice Address - Street 1:2111 E OAKLAND AVE
Practice Address - Street 2:STE. D
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-5758
Practice Address - Country:US
Practice Address - Phone:309-663-6564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.029071122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist