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Organization

SHADY OAK DENTAL LLC ORAL AND MAXILLOFACIAL SURGEONS OF NORTHWEST IL

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. SCOTT C BARES DDS (PRESIDENT)
(815) 938-2575
Entity
Organization

Contact information

Practice address
208 N WALNUT AVE, FORRESTON, IL 61030-9330
(815) 938-2575
Mailing address
208 N WALNUT AVE, FORRESTON, IL 61030-9330
(815) 938-2575

Taxonomy

Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary

Other

Enumeration date
07/30/2019
Last updated
07/30/2019
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