| Koala Center For Sleep & Tmj Disorders Mi-1 | |
|
11825 State Route 40 Suite 100 Dunlap IL 61525-8842 | |
| (309) 839-9971 | |
| (309) 807-3365 |
| Full Name | Koala Center For Sleep & Tmj Disorders Mi-1 |
|---|---|
| Speciality | Dentist |
| Location | 11825 State Route 40, Dunlap, Illinois |
| Authorized Official Name and Position | Brent Jackson (OWNER) |
| Authorized Official Contact | 8106644641 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Koala Center For Sleep & Tmj Disorders Mi-1 454 S Main St Lapeer MI 48446-2427 Ph: (810) 664-4641 | Koala Center For Sleep & Tmj Disorders Mi-1 11825 State Route 40 Suite 100 Dunlap IL 61525-8842 Ph: (309) 839-9971 |
| NPI Number | 1265887210 |
|---|---|
| Provider Enumeration Date | 04/27/2016 |
| Last Update Date | 04/27/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265887210 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 2901021258 (Michigan) | Primary |
| 122300000X | Dentist | 2901009946 (Michigan) | Secondary |
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