MEDICARE: DR. ANTHONY R BENNARDO D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019-022187	IL

General Provider Information

NPI Number	:	1245387026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY R BENNARDO D.D.S.

Provider Business Mailing Address
First Line	:	87 S MCLEAN BLVD STE B
Second Line	:
City	:	SOUTH ELGIN
State	:	IL
Zip	:	60177-1837
Country	:	US
Telephone Number	:	847-888-8311
Fax Number	:	847-429-9334

Provider Business Practice Location Address
First Line	:	87 S MCLEAN BLVD
Second Line	:
City	:	SOUTH ELGIN
State	:	IL
Zip	:	60177-1835
Country	:	US
Telephone Number	:	847-888-8311
Fax Number	:	847-429-9334

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	01/16/2026

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