Organization
FIELDCREST DENTAL, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PATRICK HAMPER (SHAREHOLDER)
(815) 452-2513
Entity
Organization
Contact information
Practice address
203 E SANTA FE AVE, TOLUCA, IL 61369
(815) 452-2513
Mailing address
203 E SANTA FE AVE, TOLUCA, IL 61369
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019027745
IL
Other
Enumeration date
12/28/2012
Last updated
12/28/2012
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