NPI 1144643966

Woodstock Dental Associates, LTD.

Organisation Exclusive Provider Organization Woodstock, IL

Practice location

Address: 666 W Jackson St STE B, Woodstock, IL 60098-3198
Phone: (815) 338-1138
Fax: (815) 338-3910

Authorised official

Name: Chungyoon Ha
Title: Associate
Phone: (815) 338-1138

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence 019025426 (IL)

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Registry record

NPI: 1144643966
Entity type: Organization
NPI issued: 30 Jan 2014
Record last updated: 30 Jan 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.