Provider Demographics
NPI:1033769997
Name:SHONKWILER FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:SHONKWILER FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SHONKWILER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:217-518-1174
Mailing Address - Street 1:110 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:ARCOLA
Mailing Address - State:IL
Mailing Address - Zip Code:61910-1417
Mailing Address - Country:US
Mailing Address - Phone:217-518-1174
Mailing Address - Fax:217-518-1175
Practice Address - Street 1:110 N OAK ST
Practice Address - Street 2:
Practice Address - City:ARCOLA
Practice Address - State:IL
Practice Address - Zip Code:61910-1417
Practice Address - Country:US
Practice Address - Phone:217-518-1174
Practice Address - Fax:217-518-1175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-12
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental