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3609 General Electric Rd Ste A Bloomington IL 61704-8766 | |
| (309) 664-6868 | |
| (309) 664-6370 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3609 General Electric Rd Ste A, Bloomington, Illinois |
| Authorized Official Name and Position | Lindsay Bearden (INS COOD) |
| Authorized Official Contact | 2175405100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3609 General Electric Rd Ste A Bloomington IL 61704-8766 Ph: (309) 664-6868 | 3609 General Electric Rd Ste A Bloomington IL 61704-8766 Ph: (309) 664-6868 |
| NPI Number | 1093937369 |
|---|---|
| Provider Enumeration Date | 05/03/2007 |
| Last Update Date | 01/04/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093937369 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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