Provider Demographics
NPI:1588246490
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 1:2215 ENTERPRISE DR STE 1504
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5804
Mailing Address - Country:US
Mailing Address - Phone:708-562-8660
Mailing Address - Fax:708-562-8660
Practice Address - Street 1:2215 ENTERPRISE DR STE 1504
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-5804
Practice Address - Country:US
Practice Address - Phone:708-562-8660
Practice Address - Fax:708-562-8660
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRU DENTAL ILLINOIS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty