Organization
ALPHA DENTAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM ANN GOSS (BUSINESS RECEPTIONIST)
(815) 223-5839
Entity
Organization
Contact information
Practice address
4105 FRONTAGE RD, PERU, IL 61354-1115
(815) 223-5839
(815) 223-0957
Mailing address
4105 FRONTAGE RD, PERU, IL 61354-1115
(815) 223-5839
(815) 223-0957
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019-022454
IL
Other
Enumeration date
01/10/2013
Last updated
01/10/2013
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