| NPI | 1851971642 |
|---|---|
| Doing Business As | INNOVATIVE DENTAL CARE OF SHOREWOOD |
| Entity Type | Organization |
| Authorized Contact | BELINDA HUERTA Credentialing Coordinator 217-540-2100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2021-04-14 |
| Last Update Date | 2023-06-14 |