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Organization
SMALLTOWN DENTAL WILLOW KNOLLS LLC
Active
Organization
SMALLTOWN DENTAL WILLOW KNOLLS LLC
Active
Parent organization
SMALLTOWN DENTAL MANAGEMENT LLC
Other names
Smalltown Dental Willow Knolls
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
6712 N MOUNTELLO DR, PEORIA, IL 61614-2328
(309) 691-7855
Mailing address
6712 N MOUNTELLO DR, PEORIA, IL 61614-2328
(309) 691-7855
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
01/21/2021
Last updated
01/21/2021
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