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Organization
PINE GLEN DENTAL GROUP, LTD
Active
Organization
PINE GLEN DENTAL GROUP, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LORI A RICE DDS (PRESIDENT)
(309) 691-1990
Entity
Organization
Contact information
Practice address
838 W GLEN AVE, PEORIA, IL 61614-4835
(309) 691-1990
(309) 691-9112
Mailing address
838 W GLEN AVE, PEORIA, IL 61614-4835
(309) 691-1990
(309) 691-9112
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
060010781
IL
Other
Enumeration date
04/06/2012
Last updated
04/06/2012
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