Organization
ADVANCED DENTAL CARE OF SPRINGFIELD LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATT GORDON VANFDERMOLEN DDS (MANAGER)
(217) 546-3333
Entity
Organization
Contact information
Practice address
4701 WABASH AVE, SPRINGFIELD, IL 62711-9694
(217) 546-3333
(217) 546-1110
Mailing address
4701 WABASH AVE, SPRINGFIELD, IL 62711-9694
(217) 546-3333
(217) 546-1110
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0190019785
DENTAL LICENSE NUMBER FOR MATT G VANDERMOLEN DDS
IL
Enumeration date
12/08/2020
Last updated
12/08/2020
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