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Organization
PEORIA DENTAL LLC
Active
Organization
PEORIA DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTT C BARES DDS (PRESIDENT)
(309) 981-5995
Entity
Organization
Contact information
Practice address
7417 N KNOXVILLE AVE, PEORIA, IL 61614-2019
(309) 981-5995
(309) 981-5981
Mailing address
7417 N KNOXVILLE AVE, PEORIA, IL 61614-2019
(309) 981-5995
(309) 981-5981
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
04/12/2018
Last updated
04/12/2018
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