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Organization
MAPLE SHADE DENTAL GROUP
Active
Organization
MAPLE SHADE DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RODNEY EARL WILLEY DDS (CEO)
(309) 243-7702
Entity
Organization
Contact information
Practice address
11825 N KNOXVILLE AVE, DUNLAP, IL 61525
(309) 243-7702
(309) 243-9559
Mailing address
11825 N KNOXVILLE AVE, DUNLAP, IL 61525
(309) 243-7702
(309) 243-9559
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
NULL
1223G0001X
General Practice Dentistry
—
—
1223P0300X
Periodontics
—
NULL
1223P0300X
Periodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
12/05/2006
Last updated
09/11/2025
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