| Granite City Dental Care Ltd | |
|
2102 N Market St Champaign IL 61822-1306 | |
| (618) 877-0780 | |
| (618) 877-8450 |
| Full Name | Granite City Dental Care Ltd |
|---|---|
| Speciality | Dentist |
| Location | 2102 N Market St, Champaign, Illinois |
| Authorized Official Name and Position | La Nae Wood (OFFICE MANAGER) |
| Authorized Official Contact | 2173512650 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Granite City Dental Care Ltd 2130 Johnson Rd Granite City IL 62040-3961 Ph: (618) 877-0780 | Granite City Dental Care Ltd 2102 N Market St Champaign IL 61822-1306 Ph: (618) 877-0780 |
| NPI Number | 1750609418 |
|---|---|
| Provider Enumeration Date | 05/05/2010 |
| Last Update Date | 05/05/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750609418 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 019.0225511 (Illinois) | Primary |
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