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General NPI Number Information
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NPI Number | 1033317847
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Entity Type | Organization
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Legal Business Name | SHOREWOOD FAMILY DENTAL CARE LLP
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 607 W JEFFERSON ST
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City | SHOREWOOD
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State | IL
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Zip | 60404-3701
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Country | US
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Telephone | 815-725-5991
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Fax | 815-725-1983
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Provider Business Mailing Address
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Address Line | 607 W JEFFERSON ST
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City | SHOREWOOD
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State | IL
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Zip | 60404-3701
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Country | US
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Telephone | 815-725-5991
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Fax | 815-725-1983
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Authorized Official
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Title or Position | MAJORITY PARTNER
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Name | DR. ROBERT S FUNK
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Credential | DMD
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Telephone | 815-725-5991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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