Provider Demographics
NPI:1831072214
Name:BLOOMINGDALE DENTAL, PLLC
Entity type:Organization
Organization Name:BLOOMINGDALE DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUBRAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-610-1041
Mailing Address - Street 1:156 E LAKE ST STE A
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1159
Mailing Address - Country:US
Mailing Address - Phone:773-610-1041
Mailing Address - Fax:
Practice Address - Street 1:156 E LAKE ST STE A
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1159
Practice Address - Country:US
Practice Address - Phone:773-610-1041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty