| Advanced Dental Care | |
|
125 Wedgewood Dr Columbia IL 62236-1052 | |
| (618) 281-9590 | |
| Not Available |
| Full Name | Advanced Dental Care |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 125 Wedgewood Dr, Columbia, Illinois |
| Authorized Official Name and Position | Martin Joseph Cisneros (OWNER) |
| Authorized Official Contact | 6182819590 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Dental Care 125 Wedgewood Dr Columbia IL 62236-1052 Ph: (618) 281-9590 | Advanced Dental Care 125 Wedgewood Dr Columbia IL 62236-1052 Ph: (618) 281-9590 |
| NPI Number | 1295182905 |
|---|---|
| Provider Enumeration Date | 05/23/2016 |
| Last Update Date | 05/23/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295182905 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 019024628 (Illinois) | Primary |
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