Provider Demographics
NPI:1174016893
Name:ABOVE & BEYOND DENISTRY, LLC
Entity Type:Organization
Organization Name:ABOVE & BEYOND DENISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHICK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:815-398-6545
Mailing Address - Street 1:364 FINANCIAL CT STE A
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-6668
Mailing Address - Country:US
Mailing Address - Phone:815-398-6545
Mailing Address - Fax:815-398-6541
Practice Address - Street 1:364 FINANCIAL CT STE A
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6668
Practice Address - Country:US
Practice Address - Phone:815-398-6545
Practice Address - Fax:815-398-6541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty