OrganizationActive
Shady Oak Dental LLC Oral and Maxillofacial Surgeons of Northwest Il
NPI 1437703113 · Oral and Maxillofacial Surgery Clinic/Center · Forreston, IL
Provider details
- NPI number
- 1437703113
- Entity type
- Organization
- Primary specialty
- Oral and Maxillofacial Surgery Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Scott Bares, President(815) 938-2575
Specialties & taxonomies
Ambulatory Health Care Facilities
Practice location
208 N Walnut Ave
Forreston, IL 61030-9330
Phone: (815) 938-2575
Approximate (ZIP-level) locationGet directions
Mailing address
208 N Walnut Ave
Forreston, IL 61030-9330
Registry dates
- Enumerated
- 2019-07-30
- Last updated
- 2019-07-30
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.