Individual
ALEXANDER JAMES BOERCKEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
4517 N ROCKWOOD DR, PEORIA, IL 61615-3841
(309) 688-0121
(309) 688-5643
Mailing address
4517 N ROCKWOOD DR, PEORIA, IL 61615-3841
(309) 688-0121
(309) 688-5643
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.030868
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1851909345
PEORIA DENTAL CARE, LLC
IL
Enumeration date
08/03/2016
Last updated
12/10/2020
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