Organization
MIDWEST ORTHODONTIC ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN C ROEHM D.D.S, M.S. (PRESIDENT)
(309) 691-9665
Entity
Organization
Contact information
Practice address
5006 N UNIVERSITY ST, PEORIA, IL 61614-4715
(309) 691-9665
(309) 691-9665
Mailing address
5006 N UNIVERSITY ST, PEORIA, IL 61614-4715
(309) 691-9665
(309) 691-9665
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1004551
—
IL
Enumeration date
02/12/2007
Last updated
08/22/2020
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