Organization
DENTAL PROFESSIONALS OF ILLINOIS, P.C
Active
Parent organization
DENTAL PROFESSIONALS OF ILLINOIS, P.C.
Other names
Innovative Dental Care of Shorewood
Organization subpart
Yes
Provider details
NPI number
Legal business name
DENTAL PROFESSIONALS OF ILLINOIS, P.C.
Authorized official
BELINDA HUERTA (CREDENTIALING COORDINATOR)
(217) 540-2100
Entity
Organization
Contact information
Practice address
1526 IL ROUTE 59, JOLIET, IL 60431-8215
(815) 436-8787
Mailing address
1526 IL ROUTE 59, JOLIET, IL 60431-8215
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
04/14/2021
Last updated
06/14/2023
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