Organization
MAPLE SHADE DENTAL (EAST PEORIA) LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE COLE (INSURANCE DIRECTOR)
(727) 726-1611
Entity
Organization
Contact information
Practice address
1001 ILLINI DR, EAST PEORIA, IL 61611-1883
(309) 694-2620
Mailing address
6240 LAKE OSPREY DR DEPT 56057, LAKEWOOD RANCH, FL 34240-8421
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
05/10/2011
Last updated
03/18/2024
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