SHADY OAK DENTAL - BYRON DENTAL LLC; NPI #1871463760

Contact Information

SHADY OAK DENTAL - BYRON DENTAL LLC

503 W BLACKHAWK DR
BYRON, IL 61010

Phone: 815-923-8080
Fax:
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Dental	261QD0000X

Indicates primary specialty

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NPI Profile & details for SHADY OAK DENTAL - BYRON DENTAL LLC

NPI #	`1871463760`
LBN Legal business name	SHADY OAK DENTAL - BYRON DENTAL LLC
Authorized official	SCOTT BARES - (PRESIDENT)
Entity	Organization
Organization subpart ¹	No
Enumeration date	11/06/2025
Last updated	11/06/2025 - About 7 months ago
Identifiers	n/a

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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