Organization
MID-ILLINOIS DENTAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENJAMIN PATRICK SOWLE DMD (OWNER)
(217) 414-4919
Entity
Organization
Contact information
Practice address
101 S CHEROKEE ST, TAYLORVILLE, IL 62568-2605
(217) 824-2201
Mailing address
1211 PEACHTREE DR, CHATHAM, IL 62629-8058
(217) 414-4919
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
08/09/2020
Last updated
08/09/2020
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