SHADY OAK DENTAL LLC ORAL AND MAXILLOFACIAL SURGEONS OF NORTHWEST IL


Address: 208 N Walnut Ave, Forreston, IL 61030-9330
Phone: 8159382575

SHADY OAK DENTAL LLC ORAL AND MAXILLOFACIAL SURGEONS OF NORTHWEST IL (NPI# 1437703113) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1437703113
Entity Type Organization
Organization Name SHADY OAK DENTAL LLC ORAL AND MAXILLOFACIAL SURGEONS OF NORTHWEST IL
Practice Address 208 N Walnut Ave
Forreston
IL 61030-9330
Practice Telephone 8159382575
Mailing Telephone 8159382575
Enumeration Date 2019-07-30
Last Update Date 2019-07-30
Authorized Official Name DR. SCOTT C BARES (PRESIDENT)
Authorized Official Telephone 8159382575
Authorized Official Credential DDS
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QS0112X Clinic/Center
Specialization: Oral and Maxillofacial Surgery
Ambulatory Health Care Facilities

Office Location

Street Address 208 N WALNUT AVE
City FORRESTON
State IL
Zip Code 61030-9330

Providers in the same location

NPI Name Taxonomy Address Enumeration
1295954089 Keith R. Ruter Dentist 208 N Walnut Ave, Forreston, IL 61030-9330 2007-04-24

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1699902080 Jennifer L Anderson Dentist 208 N. Walnut Ave, Forreston, IL 61030 2009-06-12
1407068646 Forreston Dental Dentist 510 5th Avenue, Forreston, IL 61030 2007-05-03
1992824924 Forreston Fire Protection District Ambulance 301 E. Main Street, Forreston, IL 61030-0212 2007-03-29
1366774150 Schoaf Family Chiropractic LLC Chiropractor 210 S. First Ave., Forreston, IL 61030-0307 2010-02-04
1700845104 Daniel Patrick Schoaf Chiropractor 210 S 1st Avenue, Forreston, IL 61030-0307 2006-03-23
1154580116 Brian Todd Crowe Specialist 9763 W White Eagle Rd, Forreston, IL 61030-9208 2008-06-05
1942656657 North Shore Surgical Associates General Acute Care Hospital 9763 W White Eagle Rd, Forreston, IL 61030-9208 2016-05-11
1912175936 Forrestville Valley U S D 221 Local Education Agency (LEA) 601 E Main St, Forreston, IL 61030-9474 2008-02-12
1053523704 April Moore Family Medicine 803 S First Ave, Forreston, IL 61030-9575 2007-05-04
1013051465 Freeport Regional Health Care Foundation Durable Medical Equipment & Medical Supplies 803 S 1st Ave, Forreston, IL 61030-9575 2007-02-19
Find all providers in zip 61030

Taxonomy Information

Taxonomy Code 261QS0112X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Oral and Maxillofacial Surgery

Taxonomy Definition

The specialty of dentistry which includes 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.
Notes: Source: Council on Dental Education and Licensure, American Dental Association

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1427605351 The Bloom Oral Surgery, P.C. Clinic/Center 219 N Hammes Ave Ste 1, Joliet, IL 60435-8145 2019-08-26
1528543121 Joms LLC Clinic/Center 10 Martin Ave Ste 164, Naperville, IL 60540-6563 2018-09-28
1750861209 Winterset Dental Care PC Clinic/Center 8559 S Pulaski Rd Ste 103, Chicago, IL 60652-3643 2018-08-15
1679070189 Lakeside Oral & Implant Surgery Institute, PC Clinic/Center 5758 S Maryland Ave # 4h, Chicago, IL 60637-1426 2018-04-11
1962753210 Millennium Surgical, Inc Clinic/Center 5978 S Archer Ave, Chicago, IL 60638-2817 2012-09-26
1851551642 Alan Andreas Harvey Clinic/Center 2500 Ridge Ave Ste 302, Evanston, IL 60201-2477 2008-06-15
1881808053 Oral and Maxillofacial Surgery Specalists Ltd. Clinic/Center 4035 Morsay Dr., Rockford, IL 61107-4871 2007-05-09
1962599605 Affiliated Oral & Maxillofacial Surgeons Ltd Clinic/Center 3438 N Old Arlington Heights Rd, Arlington Heights, IL 60004 2006-10-06
1598250995 Periodontics and Implant Dentistry LLC Clinic/Center 8559 S Pulaski Rd, Chicago, IL 60652-3643 2018-06-27
1205288982 Lakeside Oral & Facial Surgery Institute Clinic/Center 2500 Ridge Ave, Suite 302, Evanston, IL 60201-2455 2016-07-06
Find all providers with the same taxonomy

Competitor

Search similar providers

City FORRESTON
Zip Code 61030

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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