Organization
DR. PAUL & DR. ANDERSON, DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROGER PAUL DMD (DENTIST)
(309) 682-0770
Entity
Organization
Contact information
Practice address
521 W LAKE AVE, PEORIA, IL 61614-6020
(309) 682-0770
Mailing address
521 W. LAKE AVE, PEORIA, IL 61614
(309) 682-0770
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1916423
IL
Other
Enumeration date
12/04/2014
Last updated
12/04/2014
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