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General NPI Number Information
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NPI Number | 1851971642
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Entity Type | Organization
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Legal Business Name | DENTAL PROFESSIONALS OF ILLINOIS, P.C
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Dates
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Enumeration Date | 04/14/2021
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Last Update Date | 06/14/2023
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Provider Practice Location Address
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Address Line | 1526 IL ROUTE 59
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City | JOLIET
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State | IL
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Zip | 60431-8215
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Country | US
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Telephone | 815-436-8787
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Fax |
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Provider Business Mailing Address
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Address Line | 1526 IL ROUTE 59
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City | JOLIET
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State | IL
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Zip | 60431-8215
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | BELINDA HUERTA
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Credential |
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Telephone | 217-540-2100
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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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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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