Organization
DENTAL PROFESSIONALS OF ILLINOIS, P.C.
Active
Parent organization
DENTAL PROFESSIONALS OF ILLINOIS, P.C.
Other names
Machesney Park Family Dental
Organization subpart
Yes
Provider details
NPI number
Legal business name
DENTAL PROFESSIONALS OF ILLINOIS, P.C.
Authorized official
LINDSAY BEARDEN (CREDENTIALING COORDINATOR)
(217) 540-5699
Entity
Organization
Contact information
Practice address
1411 W LANE RD STE B, MACHESNEY PARK, IL 61115
(815) 981-9075
Mailing address
1411 W LANE RD STE B, MACHESNEY PARK, IL 61115
(815) 981-9075
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/23/2014
Last updated
09/23/2014
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