MEDICARE: ANTHONY R. BENNARDO DDS PC DBA INTEGRATIVE DENTAL HEALTH

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	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1972462810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTHONY R. BENNARDO DDS PC DBA INTEGRATIVE DENTAL HEALTH

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	:	DENTIST
Name	:	DR. ANTHONY R BENNARDO JR.
Credential	:	DDS
Telephone Number	:	847-888-8311

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

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