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NPI Profile for MAPLE SHADE DENTAL GROUP in DUNLAP, IL.
The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oral and Maxillofacial Surgery |
1223S0112X | 19 | Oral Surgery (Dentist only) | |
General Practice |
1223G0001X | |||
Periodontics |
1223P0300X |
| NPI # | 1427116854 |
|
| Status | Active | |
| Credentials | ||
| Entity | Individual | |
| Enumeration date | 12/05/2006 | |
| Last updated | 09/11/2025 - About 9 months ago | |
| Sole proprietor 1 | Not specified | |
| Identifiers | Not Available | |
| Hospital affiliation(s) | Not Available |
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MAPLE SHADE DENTAL GROUP
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MAPLE SHADE DENTAL GROUP