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Organization
BEAUTIFUL SMILES MOBILE DENTISTRY, LLC
Active
Organization
BEAUTIFUL SMILES MOBILE DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEONOR CECILIA VILLALTA DDS (MANAGING DENTIST)
(217) 722-4565
Entity
Organization
Contact information
Practice address
2547 W SPRINGFIELD AVE, APT 2, CHAMPAIGN, IL 61821-2820
(217) 552-8503
Mailing address
2547 W SPRINGFIELD AVE, APT 2, CHAMPAIGN, IL 61821-2820
(217) 552-8503
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
019029681
IL
Other
Enumeration date
02/11/2015
Last updated
02/11/2015
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