Liberty Dental, Inc | |
112 W Adams St Havana IL 62644-1337 | |
(309) 543-6301 | |
(309) 543-4958 |
Full Name | Liberty Dental, Inc |
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Speciality | Dentist - General Practice |
Location | 112 W Adams St, Havana, Illinois |
Authorized Official Name and Position | Aaron James Blakely (PRESIDENT) |
Authorized Official Contact | 3095436301 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Liberty Dental, Inc 112 W Adams St Havana IL 62644-1337 Ph: (309) 543-6301 | Liberty Dental, Inc 112 W Adams St Havana IL 62644-1337 Ph: (309) 543-6301 |
NPI Number | 1649516295 |
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Provider Enumeration Date | 12/28/2012 |
Last Update Date | 12/28/2012 |
Identifier | Type | State | Issuer |
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1649516295 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1223G0001X | Dentist - General Practice | 019024184 (Illinois) | Primary |
Stinauer Family Dentistry Inc. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 312 W Main St, Havana, IL 62644 Phone: 309-543-2975 Fax: 309-543-2782 |