Organization
DENTAL PROFESSIONALS OF ILLINOIS, P.C.
Active
Parent organization
DENTAL PROFESSIONALS OF ILLINOIS, P.C.
Other names
Station Side Dental Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
DENTAL PROFESSIONALS OF ILLINOIS, P.C.
Authorized official
JESSICA BRITT (CREDENTIALING COORDINATOR)
(217) 540-5100
Entity
Organization
Contact information
Practice address
3419 ORCHARD RD, OSWEGO, IL 60543-5005
(331) 717-0251
(331) 999-3073
Mailing address
3419 ORCHARD RD, OSWEGO, IL 60543-5005
(331) 717-0251
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
04/24/2020
Last updated
01/15/2021
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