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Organization
SMALLTOWN DENTAL ON FOURTH LLC
Active
Organization
SMALLTOWN DENTAL ON FOURTH LLC
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
1600 S 4TH AVE STE 110, MORTON, IL 61550-3401
(309) 263-2781
Mailing address
1600 S 4TH AVE STE 110, MORTON, IL 61550-3401
(309) 263-2781
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/25/2022
Last updated
10/25/2022
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