Organization
ACCESS DENTAL OF PEORIA OPTIM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA CARRILLO (REGIONAL MANAGER)
(512) 351-2612
Entity
Organization
Contact information
Practice address
1200 W MAIN ST STE 9, PEORIA, IL 61606-1218
(309) 777-9777
Mailing address
8150 SPRINGWOOD DR # 150B, IRVING, TX 75063-5810
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
12/09/2021
Last updated
12/09/2021
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