Provider Demographics
NPI:1457921108
Name:BUDNEY, PATRICK (DMD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:BUDNEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 S MICHIGAN AVE APT 1205
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3269
Mailing Address - Country:US
Mailing Address - Phone:815-347-2268
Mailing Address - Fax:
Practice Address - Street 1:221 N WEBER RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60490-1508
Practice Address - Country:US
Practice Address - Phone:815-347-2268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0332371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice