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1411 W Lane Rd Ste B Machesney Park IL 61115 | |
| (815) 981-9075 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1411 W Lane Rd Ste B, Machesney Park, Illinois |
| Authorized Official Name and Position | Lindsay Bearden (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2175405699 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1411 W Lane Rd Ste B Machesney Park IL 61115 Ph: (815) 981-9075 | 1411 W Lane Rd Ste B Machesney Park IL 61115 Ph: (815) 981-9075 |
| NPI Number | 1053713966 |
|---|---|
| Provider Enumeration Date | 09/23/2014 |
| Last Update Date | 09/23/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053713966 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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