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General NPI Number Information
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NPI Number | 1831437797
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Entity Type | Individual
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Provider Name | EVA J BLODA DDS
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Gender | Female
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Dates
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Enumeration Date | 01/27/2013
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 2103 E WASHINGTON ST STE 1C
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City | BLOOMINGTON
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State | IL
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Zip | 61701-4365
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Country | US
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Telephone | 847-707-7210
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Fax |
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Provider Business Mailing Address
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Address Line | 6418 W BELMONT AVE
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City | CHICAGO
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State | IL
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Zip | 60634-4099
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Country | US
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Telephone | 773-622-7773
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Fax | 773-286-5966
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 019.022086
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D.007255-C
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License Number State | AL
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