Malta Family Dental Llc | |
304 Van Buren St Malta IL 60150-9512 | |
(815) 825-5025 | |
(815) 516-0205 |
Full Name | Malta Family Dental Llc |
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Speciality | Dentist |
Location | 304 Van Buren St, Malta, Illinois |
Authorized Official Name and Position | Anne Elizabeth Anderson (OFFICE MANAGER) |
Authorized Official Contact | 8158255025 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Malta Family Dental Llc 304 Van Buren St Malta IL 60150-9512 Ph: (815) 825-5025 | Malta Family Dental Llc 304 Van Buren St Malta IL 60150-9512 Ph: (815) 825-5025 |
NPI Number | 1063791218 |
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Provider Enumeration Date | 08/05/2011 |
Last Update Date | 08/05/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1063791218 | NPI | - | NPPES |
019027588 | Medicaid | IL | |
020010952 | Medicaid | IL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 019027588 (Illinois) | Primary |
124Q00000X | Dental Hygienist | 020010952 (Illinois) | Secondary |