Organization
FARRELL
Active
Parent organization
TWO RIVERS DENTAL PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
TWO RIVERS DENTAL PC
Authorized official
SOHAIL S SHAFI (MANAGER)
(630) 842-3705
Entity
Organization
Contact information
Practice address
16533 W 159TH ST, LOCKPORT, IL 60441-7900
(815) 836-3700
(815) 836-3701
Mailing address
1730 PARK ST STE 106, NAPERVILLE, IL 60563-2609
(815) 836-3700
(815) 836-3701
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
01/27/2010
Last updated
12/10/2020
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