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Organization
SMALLTOWN DENTAL PEORIA LLC
Active
Organization
SMALLTOWN DENTAL PEORIA LLC
Active
Parent organization
SMALLTOWN DENTAL MANAGEMENT LLC
Other names
Smalltown Dental Peoria
Organization subpart
Yes
Provider details
NPI number
Legal business name
SMALLTOWN DENTAL MANAGEMENT LLC
Authorized official
LUKE OVERCASH (OPERATIONS MANAGER)
(309) 370-5853
Entity
Organization
Contact information
Practice address
2106 N KNOXVILLE AVE, PEORIA, IL 61603-2417
(309) 685-3814
Mailing address
17471 MOORE RD, MORTON, IL 61550-9222
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
11/04/2020
Last updated
11/04/2020
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