Healthcare Provider Details

I. General information

NPI: 1609548817
Provider Name (Legal Business Name): BDD OF ILLINOIS P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 04/19/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

784 W ARMY TRAIL RD
CAROL STREAM IL
60188-9297
US

IV. Provider business mailing address

333 W 1ST ST
ELMHURST IL
60126-2641
US

V. Phone/Fax

Practice location:
  • Phone: 630-289-8899
  • Fax:
Mailing address:
  • Phone: 312-805-8590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: JAY JORBIN
Title or Position: CFO
Credential:
Phone: 312-805-8590