Freeport Dental

NPI #1891165643 in Freeport, Illinois

Provider Information

NPI Number: 1891165643
Entity Type: Organization
Organization Name: Freeport Dental
Subpart: Yes (part of a larger organization)
Parent Organization: SHADYOAK DENTAL
Primary Specialty: Dentist - General Practice
Enumeration Date: Oct 5, 2015
Last Updated: Oct 5, 2015

Practice Location

Address: 1450 S WEST AVE
City: Freeport
State: Illinois
ZIP Code: 61032-6351
Phone: (815) 656-4060

Authorized Official

Name: SCOTT BARES
Title: OWNER
Phone: (815) 656-4060

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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