| Prairie Dental Associates | |
|
3220 Gerig Dr Bloomington IL 61704-6394 | |
| (309) 662-7722 | |
| Not Available |
| Full Name | Prairie Dental Associates |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3220 Gerig Dr, Bloomington, Illinois |
| Authorized Official Name and Position | Daniel Jacobsen (PARTNER) |
| Authorized Official Contact | 3096627722 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prairie Dental Associates 3220 Gerig Dr Bloomington IL 61704-6394 Ph: (309) 662-7722 | Prairie Dental Associates 3220 Gerig Dr Bloomington IL 61704-6394 Ph: (309) 662-7722 |
| NPI Number | 1629403167 |
|---|---|
| Provider Enumeration Date | 09/03/2013 |
| Last Update Date | 09/03/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629403167 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 019.028635 (Illinois) | Primary |
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