Healthcare Provider Details

I. General information

NPI: 1851225700
Provider Name (Legal Business Name): BLOSSOM ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7130 DEMPSTER ST
MORTON GROVE IL
60053-2053
US

IV. Provider business mailing address

7130 DEMPSTER ST
MORTON GROVE IL
60053-2053
US

V. Phone/Fax

Practice location:
  • Phone: 224-601-6012
  • Fax: 224-601-6019
Mailing address:
  • Phone: 224-601-6012
  • Fax: 224-601-6019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SHERRY DEOL
Title or Position: ORTHODONTIST
Credential: DMD
Phone: 224-601-6012