Provider Demographics
NPI:1770796005
Name:BELNIAK & BRINK DDS,LTD
Entity type:Organization
Organization Name:BELNIAK & BRINK DDS,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BODEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-665-7474
Mailing Address - Street 1:10 DANADA SQ W
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-1000
Mailing Address - Country:US
Mailing Address - Phone:630-665-7474
Mailing Address - Fax:630-668-0056
Practice Address - Street 1:10 DANADA SQ W
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-1000
Practice Address - Country:US
Practice Address - Phone:630-665-7474
Practice Address - Fax:630-668-0056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.018126122300000X
IL019.024764122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty