Provider Demographics
NPI:1780780197
Name:BLECHA, NOWELL EDWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:NOWELL
Middle Name:EDWARD
Last Name:BLECHA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 W MARTIN AVE STE 164
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6563
Mailing Address - Country:US
Mailing Address - Phone:630-961-5151
Mailing Address - Fax:630-961-5173
Practice Address - Street 1:10 W MARTIN AVE STE 164
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6563
Practice Address - Country:US
Practice Address - Phone:630-961-5151
Practice Address - Fax:630-961-5173
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL791290Medicare UPIN