| Maple Shade Dental Camp Street Llc | |
|
809 W Camp St East Peoria IL 61611-7218 | |
| (309) 694-0606 | |
| Not Available |
| Full Name | Maple Shade Dental Camp Street Llc |
|---|---|
| Speciality | Dentist |
| Location | 809 W Camp St, East Peoria, Illinois |
| Authorized Official Name and Position | Mike Cole (INSURANCE DIRECTOR) |
| Authorized Official Contact | 7277261611 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Maple Shade Dental Camp Street Llc 809 W Camp St East Peoria IL 61611-7218 Ph: () - | Maple Shade Dental Camp Street Llc 809 W Camp St East Peoria IL 61611-7218 Ph: (309) 694-0606 |
| NPI Number | 1497003156 |
|---|---|
| Provider Enumeration Date | 08/28/2012 |
| Last Update Date | 08/28/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497003156 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (Illinois) | Primary |
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