|
| |
|
110 W Center St Ottawa IL 61350-3557 | |
| (815) 434-6411 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 110 W Center St, Ottawa, Illinois |
| Authorized Official Name and Position | Min Kim (OWNER) |
| Authorized Official Contact | 3145032066 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4260 Westbrook Dr Ste 105 Aurora IL 60504-8136 Ph: () - | 110 W Center St Ottawa IL 61350-3557 Ph: (815) 434-6411 |
| NPI Number | 1497523559 |
|---|---|
| Provider Enumeration Date | 12/18/2023 |
| Last Update Date | 12/30/2024 |
| Medicare PECOS PAC ID | 8123560463 |
|---|---|
| Medicare Enrollment ID | O20240603000823 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497523559 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
| Provider Name | Min Soo Kim |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1528449873 PECOS PAC ID: 9830631175 Enrollment ID: I20240603002142 |
John M Conness Dds Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1704 Polaris Cir, Suite 1, Ottawa, IL 61350 Phone: 815-434-1022 Fax: 815-434-1047 | |
Mark Benavides D.d.s., P.c. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1703 Polaris Cir, Ottawa, IL 61350 Phone: 815-434-0152 | |
Ottawa Children's Dentistry, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1704 Polaris Cir, Ottawa, IL 61350 Phone: 815-434-6447 Fax: 815-434-2828 | |
John C Harbeck Dds Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1210 W Madison St, Ottawa, IL 61350 Phone: 815-433-1242 Fax: 815-433-6931 | |
Richard A Ewald And William L Wrobel Dds Ltd Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1704 Polaris Cir, Ottawa, IL 61350 Phone: 815-434-6447 |