| Tmj & Sleep Apnea Center Of Central Il | |
|
731 Sabrina Dr Suite A East Peoria IL 61611-3581 | |
| (309) 699-1300 | |
| Not Available |
| Full Name | Tmj & Sleep Apnea Center Of Central Il |
|---|---|
| Speciality | Dentist |
| Location | 731 Sabrina Dr, East Peoria, Illinois |
| Authorized Official Name and Position | Jack G Walz (CEO/DIRECTOR) |
| Authorized Official Contact | 3096991300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tmj & Sleep Apnea Center Of Central Il 731 Sabrina Dr Suite A East Peoria IL 61611-3581 Ph: (309) 699-1300 | Tmj & Sleep Apnea Center Of Central Il 731 Sabrina Dr Suite A East Peoria IL 61611-3581 Ph: (309) 699-1300 |
| NPI Number | 1962745232 |
|---|---|
| Provider Enumeration Date | 04/04/2013 |
| Last Update Date | 04/04/2013 |
| Medicare PECOS PAC ID | 7719168731 |
|---|---|
| Medicare Enrollment ID | O20130617000038 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962745232 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 060008862 (Illinois) | Primary |
| Provider Name | Jack Walz |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1427166008 PECOS PAC ID: 3971784901 Enrollment ID: I20130617000060 |
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