SHADY OAK DENTAL LLC ORAL AND MAXILLOFACIAL SURGEONS OF NORTHWEST IL is an oral and maxillofacial surgery clinic center in Forreston, IL. The provider is an oral and maxillofacial surgery clinic or center specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. SHADY OAK DENTAL LLC ORAL AND MAXILLOFACIAL SURGEONS OF NORTHWEST IL NPI is 1437703113. The provider is registered as an organization entity type.
The provider's business location address is:
208 N WALNUT AVE FORRESTON, IL ZIP 61030-330 Phone: (815) 938-2575
The provider's authorized official is Scott C Bares . The authorized official title is President and has the following contact phone number (815) 938-2575.
The enumeration date for this NPI number is 7/30/2019 and was last updated on 7/30/2019.
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.
This page was last updated on: 3/30/2025
NPI Synchronization or Removal
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