Organization
AL WEATHERFORD DDS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALVIN D WEATHERFORD JR. DDS (DENTIST)
(815) 932-3616
Entity
Organization
Contact information
Practice address
200 E COURT ST, SUITE 504, KANKAKEE, IL 60901-3843
(815) 932-3613
Mailing address
200 E COURT ST, SUITE 504, KANKAKEE, IL 60901-3843
(815) 932-3613
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
BW5933153
IL
Other
Enumeration date
07/01/2013
Last updated
07/01/2013
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