Organization
MAPLE SHADE DENTAL (DUNLAP) LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICTORIA J JOHNSON (CRO)
(941) 444-0558
Entity
Organization
Contact information
Practice address
11825 STATE ROUTE 40, SUITE 200, DUNLAP, IL 61525-8842
(309) 243-7702
(309) 243-9061
Mailing address
6240 LAKE OSPREY DR DEPT 56058, LAKEWOOD RANCH, FL 34240-8421
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
07/05/2011
Last updated
07/21/2026
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