Organization
32 COTTAGE DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMANTHA HERNANDEZ (RCM CREDENTIALING MANAGER)
(331) 645-5299
Entity
Organization
Contact information
Practice address
2206 COTTAGE AVE, BLOOMINGTON, IL 61701-1447
(309) 828-1463
Mailing address
2206 COTTAGE AVE, BLOOMINGTON, IL 61701-1447
(309) 828-1463
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
07/24/2025
Last updated
03/20/2026
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