Organization
PETERSON DENTAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES PETERSON DDS (OWNER)
(630) 780-9964
Entity
Organization
Contact information
Practice address
2501 W ILES AVE STE A, SPRINGFIELD, IL 62704-6482
(217) 787-4015
Mailing address
1700 MOUND RD, JACKSONVILLE, IL 62650-2260
(630) 780-9964
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019029045
IL
Other
Enumeration date
06/08/2018
Last updated
04/16/2025
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