Shady Oak Dental - Byron Dental LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

SHADY OAK DENTAL - BYRON DENTAL LLC

Practice address

503 W Blackhawk Dr
Byron, IL 61010-9647

Phone

(309) 369-3284

NPI assigned

Nov 6, 2025

Last updated

Nov 6, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Scott Bares, DDS

Title

President

Phone

(815) 275-2680

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1762387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762387200000",
    "number": "1871463760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1342 S HARLEM AVE",
            "city": "FREEPORT",
            "state": "IL",
            "postal_code": "610326231",
            "telephone_number": "309-369-3284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 W BLACKHAWK DR",
            "city": "BYRON",
            "state": "IL",
            "postal_code": "610109647",
            "telephone_number": "309-369-3284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADY OAK DENTAL - BYRON DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-11-06",
        "last_updated": "2025-11-06",
        "certification_date": "2025-11-06",
        "status": "A",
        "authorized_official_last_name": "BARES",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-275-2680",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• RMJ Partnership (Hulsebus Chiropractic Clinic of Byron)
• Emily Rogers, MD
• Kelly Ann Rogers, PTA, LMT, BS
• Carissa Rognstad, SLP
• Brittney Faustine Semple, MS, CD(DONA), CLC
• Katharine Anne Sherburne, PHARM D
• Sinnissippi Centers, Inc.
• Sinnissippi Centers, Inc.
• Jessica Lynn Skinner, FNP-BC
• Lisa A Stear, LCSW

• Dental Clinic/Center in Byron, IL
• Providers in Byron, IL by specialty
• Dental Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.