Healthcare Provider Details

I. General information

NPI: 1053103481
Provider Name (Legal Business Name): USN DENTAL SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 W STEPHENSON ST
FREEPORT IL
61032-4941
US

IV. Provider business mailing address

804 W STEPHENSON ST
FREEPORT IL
61032-4941
US

V. Phone/Fax

Practice location:
  • Phone: 815-235-7476
  • Fax:
Mailing address:
  • Phone: 815-235-7476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL VICTOR WRIGHT
Title or Position: OWNER/ORTHODONTIST
Credential: DMD
Phone: 630-272-7776