Organization
COAL CITY DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBIN LYNN TREVISON D.M.D. (DENTIST)
(815) 634-4999
Entity
Organization
Contact information
Practice address
645 E DIVISION ST, COAL CITY, IL 60416-1679
(815) 634-4999
(815) 634-0014
Mailing address
645 E DIVISION ST, COAL CITY, IL 60416-1679
(815) 634-4999
(815) 634-0014
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019020745
IL
Other
Enumeration date
06/21/2012
Last updated
06/21/2012
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