Organization
AUTUMN DENTAL OF MOKENA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTT BARES DDS (OWNER)
(815) 275-2680
Entity
Organization
Contact information
Practice address
19848 S LA GRANGE RD, MOKENA, IL 60448-9339
(708) 995-1859
Mailing address
208 N WALNUT AVE, FORRESTON, IL 61030-9330
(815) 938-2575
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019027024
IL
Other
Enumeration date
09/07/2017
Last updated
09/07/2017
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