Maple Shade Dental (dunlap) LLC

NPI #1134416795 in Dunlap, Illinois

Provider Information

NPI Number: 1134416795
Entity Type: Organization
Organization Name: Maple Shade Dental (dunlap) LLC
Primary Specialty: Dentist
Enumeration Date: Jul 5, 2011
Last Updated: Mar 18, 2024

Practice Location

Address: 11825 STATE ROUTE 40
Address 2: SUITE 200
City: Dunlap
State: Illinois
ZIP Code: 61525-8842
Phone: (309) 243-7702

Authorized Official

Name: MIKE COLE
Title: INSURANCE DIRECTOR
Phone: (727) 726-1611

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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