Organization
DENTAL PROFESSIONALS OF ILLINOIS, P.C
Active
Parent organization
DENTAL PROFESSIONALS OF ILLINOIS, P.C.
Other names
Innovative Orthodontic Centers
Organization subpart
Yes
Provider details
NPI number
Legal business name
DENTAL PROFESSIONALS OF ILLINOIS, P.C.
Authorized official
TABATHA LEMKE (CREDENTIALING COORDINATOR)
(217) 540-6078
Entity
Organization
Contact information
Practice address
55 S MAIN ST STE 271, NAPERVILLE, IL 60540-8044
(630) 848-6960
Mailing address
55 S MAIN ST STE 271, NAPERVILLE, IL 60540-8044
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
05/11/2021
Last updated
06/04/2021
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