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Organization
SB ILLINOIS DENTISTRY LLC
Active
Organization
SB ILLINOIS DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHACHINDRA BAHADUR (OWNER)
(319) 390-1400
Entity
Organization
Contact information
Practice address
2506 VOLUNTEER DR, GALESBURG, IL 61401-8654
(309) 341-4630
Mailing address
PO BOX 3189, SYRACUSE, NY 13220-3189
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
01/09/2018
Last updated
01/09/2018
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