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Organization
SMALLTOWN DENTAL BLOOMINGTON ON MALONEY
Active
Organization
SMALLTOWN DENTAL BLOOMINGTON ON MALONEY
Active
Parent organization
SMALLTOWN DENTAL MANAGEMENT LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
SMALLTOWN DENTAL MANAGEMENT LLC
Authorized official
LUKE OVERCASH (CIO)
(309) 370-5853
Entity
Organization
Contact information
Practice address
2433 MALONEY DR, BLOOMINGTON, IL 61704-3750
(309) 662-9042
Mailing address
1600 S 4TH AVE STE 110, MORTON, IL 61550-3401
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/14/2023
Last updated
03/14/2023
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