Organization
ADVANCED DENTAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARTIN JOSEPH CISNEROS D.M.D (OWNER)
(618) 281-9590
Entity
Organization
Contact information
Practice address
125 WEDGEWOOD DR, COLUMBIA, IL 62236-1052
(618) 281-9590
Mailing address
125 WEDGEWOOD DR, COLUMBIA, IL 62236-1052
(618) 281-9590
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019024628
IL
Other
Enumeration date
05/23/2016
Last updated
05/23/2016
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