# PRAIRIE CIRCLE DENTAL, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Dr. Richard D. Davidson
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912036385
- **Authorized official:** DR. RICHARD D. DAVIDSON DMD (OWNER)
- **Authorized official phone:** (217) 253-5216

## Contact information

- **Practice address:** 703 N NILES AVE, TUSCOLA, IL 61953-1059
- **Practice address phone:** (217) 253-5216
- **Practice address fax:** (217) 253-4949
- **Mailing address:** 703 N NILES AVE, TUSCOLA, IL 61953-1059
- **Mailing address phone:** (217) 253-5216
- **Mailing address fax:** (217) 253-4949

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | IL | Yes |

## Other

- **Enumeration date:** 03/03/2007
- **Last updated:** 08/22/2020