Provider Demographics
NPI:1659545762
Name:COUNTY OF MCHENRY
Entity Type:Organization
Organization Name:COUNTY OF MCHENRY
Other - Org Name:MCHENRY COUNTY DEPARTMENT OF HEALTH DENTAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BELLIDO-GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:815-337-5616
Mailing Address - Street 1:237 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098
Mailing Address - Country:US
Mailing Address - Phone:815-337-5616
Mailing Address - Fax:815-337-5624
Practice Address - Street 1:237 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098
Practice Address - Country:US
Practice Address - Phone:815-337-5616
Practice Address - Fax:815-337-5624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223D0001X
IL1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty