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General NPI Number Information
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NPI Number | 1578684262
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Entity Type | Organization
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Legal Business Name | BLISS AND BLACKMAN LTD.
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 400 N GARY AVE
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City | CAROL STREAM
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State | IL
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Zip | 60188-4916
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Country | US
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Telephone | 630-260-0333
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Fax | 630-260-2981
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Provider Business Mailing Address
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Address Line | 400 N GARY AVE
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City | CAROL STREAM
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State | IL
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Zip | 60188-4916
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Country | US
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Telephone | 630-260-0333
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Fax | 630-260-2981
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ROGER ZENAS BLISS
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Credential | DDS
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Telephone | 630-260-0333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | IL
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