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Organization
PRAIRIE DENTAL ASSOCIATES, P.C.
Active
Organization
PRAIRIE DENTAL ASSOCIATES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD A. STEPHEY DDS (CEO)
(309) 662-7722
Entity
Organization
Contact information
Practice address
3220 GERIG DR, BLOOMINGTON, IL 61704-6394
(309) 662-7722
Mailing address
3220 GERIG DR, BLOOMINGTON, IL 61704-6394
(309) 662-7722
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IL
Other
Enumeration date
09/10/2007
Last updated
09/10/2007
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