Organization
BUFFALO PRAIRIE DENTAL CARE OF MACOMB, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL O CONNOLLY DDS (PRESIDENT)
(309) 833-2882
Entity
Organization
Contact information
Practice address
200 S MCARTHUR ST, MACOMB, IL 61455-2143
(309) 833-2882
(309) 833-3210
Mailing address
200 S MCARTHUR ST, MACOMB, IL 61455-2143
(309) 833-2882
(309) 833-3210
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019025916
IL
Other
Enumeration date
08/09/2006
Last updated
07/17/2008
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