Provider Demographics
NPI:1487478707
Name:BLISS DENTAL LLC
Entity type:Organization
Organization Name:BLISS DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AQIL
Authorized Official - Middle Name:
Authorized Official - Last Name:VALIKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:224-402-4382
Mailing Address - Street 1:1400 LINCOLN HWY STE B
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-3580
Mailing Address - Country:US
Mailing Address - Phone:630-549-7916
Mailing Address - Fax:
Practice Address - Street 1:1400 LINCOLN HWY STE B
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-3580
Practice Address - Country:US
Practice Address - Phone:630-549-7916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty