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1507 North Veterans Parkway Bloomington IL 61704 | |
| (309) 664-6666 | |
| (309) 662-0252 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1507 North Veterans Parkway, Bloomington, Illinois |
| Authorized Official Name and Position | Amy Kroeger (INS COOD) |
| Authorized Official Contact | 2175405100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1507 North Veterans Parkway Bloomington IL 61704 Ph: (309) 664-6666 | 1507 North Veterans Parkway Bloomington IL 61704 Ph: (309) 664-6666 |
| NPI Number | 1265654412 |
|---|---|
| Provider Enumeration Date | 05/03/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265654412 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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