Provider Demographics
NPI:1437734886
Name:TRU DENTAL ILLINOIS, P.C.
Entity type:Organization
Organization Name:TRU DENTAL ILLINOIS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:931 W 75TH ST STE 107
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-7200
Mailing Address - Country:US
Mailing Address - Phone:630-357-9393
Mailing Address - Fax:630-357-9393
Practice Address - Street 1:931 W 75TH ST STE 107
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-7200
Practice Address - Country:US
Practice Address - Phone:630-357-9393
Practice Address - Fax:630-357-9393
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRU DENTAL ILLINOIS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty