Healthcare Provider Details

I. General information

NPI: 1063327336
Provider Name (Legal Business Name): JAVAN CORY RAYMOND BANDY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E NORTHWEST HWY
ARLINGTON HEIGHTS IL
60004-6126
US

IV. Provider business mailing address

3930 PANDOLA AVE
JOLIET IL
60431-8839
US

V. Phone/Fax

Practice location:
  • Phone: 847-398-0811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.037464
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: