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Organization
PRAIRIE AVENUE DENTAL ASSOCIATES, INC.
Active
Organization
PRAIRIE AVENUE DENTAL ASSOCIATES, INC.
Active
Parent organization
RENEE E. SCHULTZ DIETZ
Other names
Renee Schultz Dietz
Organization subpart
Yes
Provider details
NPI number
Legal business name
RENEE E. SCHULTZ DIETZ
Authorized official
DR. RENEE E. DIETZ D.M.D. (OWNER)
(815) 648-4095
Entity
Organization
Contact information
Practice address
12016 PRAIRIE AVE, POST OFFICE BOX 75, HEBRON, IL 60034-8892
(815) 648-4095
(815) 648-2881
Mailing address
12016 PRAIRIE AVE, POST OFFICE BOX 75, HEBRON, IL 60034-8892
(815) 648-4095
(815) 648-2881
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IL
Other
Enumeration date
10/04/2007
Last updated
10/04/2007
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