Provider Demographics
NPI:1033317847
Name:SHOREWOOD FAMILY DENTAL CARE LLP
Entity Type:Organization
Organization Name:SHOREWOOD FAMILY DENTAL CARE LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAJORITY PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:FUNK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:815-725-5991
Mailing Address - Street 1:607 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404-3701
Mailing Address - Country:US
Mailing Address - Phone:815-725-5991
Mailing Address - Fax:815-725-1983
Practice Address - Street 1:607 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404-3701
Practice Address - Country:US
Practice Address - Phone:815-725-5991
Practice Address - Fax:815-725-1983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty