Organization
HOUSKA DENTAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK HOUSKA (OWNER)
(309) 662-9042
Entity
Organization
Contact information
Practice address
2433 MALONEY DR, BLOOMINGTON, IL 61704-3750
(309) 662-9042
Mailing address
2433 MALONEY DR, BLOOMINGTON, IL 61704-3750
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019020622
IL
Other
Enumeration date
08/15/2012
Last updated
08/15/2012
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