Provider Demographics
NPI:1649653213
Name:WILLOWBROOK DENTISTRY FOR CHILDREN, LLC
Entity type:Organization
Organization Name:WILLOWBROOK DENTISTRY FOR CHILDREN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:YUE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-570-0858
Mailing Address - Street 1:7000 S ADAMS ST STE 111
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-7565
Mailing Address - Country:US
Mailing Address - Phone:630-570-0858
Mailing Address - Fax:
Practice Address - Street 1:7000 S ADAMS ST STE 111
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-7565
Practice Address - Country:US
Practice Address - Phone:630-570-0858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-01
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty