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Organization
CHILDREN'S CENTER FOR DENTISTRY PLLC
Active
Organization
CHILDREN'S CENTER FOR DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREGORY M DIETZ D.M.D (OWNER & PROVIDER)
(309) 827-5437
Entity
Organization
Contact information
Practice address
314 SUSAN DRIVE, NORMAL, IL 61761
(309) 827-5437
(309) 265-0288
Mailing address
314 SUSAN DRIVE, NORMAL, IL 61761
(309) 827-5437
(309) 265-0288
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
019027386
IL
1223G0001X
General Practice Dentistry
—
NULL
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
Primary
021002544
IL
Other
Enumeration date
10/13/2016
Last updated
05/28/2021
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