| West Side Family Dentistry, Ltd | |
|
709 Plaza Dr Mendota IL 61342-2457 | |
| (815) 539-7004 | |
| (815) 539-7060 |
| Full Name | West Side Family Dentistry, Ltd |
|---|---|
| Speciality | Dentist |
| Location | 709 Plaza Dr, Mendota, Illinois |
| Authorized Official Name and Position | Keri Lynn Sundberg (DENTIST/PRESIDENT) |
| Authorized Official Contact | 8155397004 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| West Side Family Dentistry, Ltd 709 Plaza Dr Mendota IL 61342-2457 Ph: (815) 539-7004 | West Side Family Dentistry, Ltd 709 Plaza Dr Mendota IL 61342-2457 Ph: (815) 539-7004 |
| NPI Number | 1245617570 |
|---|---|
| Provider Enumeration Date | 05/06/2015 |
| Last Update Date | 10/05/2022 |
| Medicare PECOS PAC ID | 5294757613 |
|---|---|
| Medicare Enrollment ID | O20051229000347 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245617570 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 019-025531 (Illinois) | Primary |
| Provider Name | Keri L Sundberg |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1568536845 PECOS PAC ID: 6800819681 Enrollment ID: I20060109000147 |
Ernesto A Villalobos, Dds, Ms, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1318 Meriden St, Mendota, IL 61342 Phone: 815-539-3000 | |
Krenz Dental Corp. Ltd Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 704 Indiana Ave, Mendota, IL 61342 Phone: 815-538-5316 Fax: 815-539-7626 |