National Provider Identifier Database

MAPLE SHADE DENTAL GROUP
Oral and Maxillofacial Surgery

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.


Contact Information

MAPLE SHADE DENTAL GROUP
11825 N KNOXVILLE AVE
DUNLAP, IL61525
Phone: 309-243-7702
Fax: 309-243-9559
Website:
Specialty Taxonomy Code
* Oral and Maxillofacial Surgery 1223S0112X
General Practice 1223G0001X
Periodontics 1223P0300X

* Indicates primary specialty

NPI Profile & details for MAPLE SHADE DENTAL GROUP

NPI Number 1427116854
Legal business name
LBN
MAPLE SHADE DENTAL GROUP
Authorized official RODNEY WILLEY - (CEO)
Entity Organization
Organization subpart No
Enumeration date 12/05/2006
Last updated 09/11/2025 - About 9 months ago
Sole proprietor1 Not specified
Identifiers n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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