| Broadway Family Dental Center | |
|
595 N Broadway St Coal City IL 60416-1046 | |
| (815) 634-8009 | |
| (815) 634-2008 |
| Full Name | Broadway Family Dental Center |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 595 N Broadway St, Coal City, Illinois |
| Authorized Official Name and Position | Peter J Pullara (DENTIST/OWNER) |
| Authorized Official Contact | 8156348009 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Broadway Family Dental Center 595 N Broadway St Coal City IL 60416-1046 Ph: (815) 634-8009 | Broadway Family Dental Center 595 N Broadway St Coal City IL 60416-1046 Ph: (815) 634-8009 |
| NPI Number | 1922378900 |
|---|---|
| Provider Enumeration Date | 01/06/2012 |
| Last Update Date | 01/06/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922378900 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 019021493 (Illinois) | Primary |
Coal City Dental Center Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 645 E Division St, Coal City, IL 60416 Phone: 815-634-4999 Fax: 815-634-0014 | |
Plainfield Family Dental Center Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 595 N Broadway St, Coal City, IL 60416 Phone: 815-634-8009 Fax: 815-634-2008 |