Provider Demographics
NPI:1922419274
Name:AFO DENTAL GROUP, LTD
Entity Type:Organization
Organization Name:AFO DENTAL GROUP, LTD
Other - Org Name:STILLWATER DENTAL GROUP, LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-922-0600
Mailing Address - Street 1:2959 ARTESIAN RD
Mailing Address - Street 2:SUITE 127
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8547
Mailing Address - Country:US
Mailing Address - Phone:630-809-6678
Mailing Address - Fax:630-922-9190
Practice Address - Street 1:2959 ARTESIAN RD
Practice Address - Street 2:SUITE 127
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8547
Practice Address - Country:US
Practice Address - Phone:630-809-6678
Practice Address - Fax:630-922-9190
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFO DENTAL GROUP, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19.021254122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty