Provider Demographics
NPI:1316522766
Name:TRU DENTAL ILLINOIS II PLLC
Entity type:Organization
Organization Name:TRU DENTAL ILLINOIS II PLLC
Other - Org Name:<UNAVAIL>
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 1:2418 W INDIAN TRL STE E
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-1590
Mailing Address - Country:US
Mailing Address - Phone:630-907-2180
Mailing Address - Fax:630-907-2180
Practice Address - Street 1:2418 W INDIAN TRL STE E
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1590
Practice Address - Country:US
Practice Address - Phone:630-907-2180
Practice Address - Fax:630-907-2180
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRU DENTAL ILLINOIS II PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-16
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty