Organization
DENTAL PROFESSIONALS OF ILLINOIS, P.C
Active
Parent organization
DENTAL PROFESSIONALS OF ILLINOIS, P.C
Other names
Countryside Dental Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
DENTAL PROFESSIONALS OF ILLINOIS, P.C
Authorized official
HILLARY THULL (CREDENTIALING COORDINATOR)
(217) 540-8946
Entity
Organization
Contact information
Practice address
6335 JOLIET RD STE 200, COUNTRYSIDE, IL 60525-3986
(708) 352-1830
Mailing address
6335 JOLIET RD STE 200, COUNTRYSIDE, IL 60525-3986
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/11/2021
Last updated
10/11/2021
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