Organization
LIBERTY DENTAL, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AARON JAMES BLAKELY D.M.D. (PRESIDENT)
(309) 543-6301
Entity
Organization
Contact information
Practice address
112 W ADAMS ST, HAVANA, IL 62644-1337
(309) 543-6301
(309) 543-4958
Mailing address
112 W ADAMS ST, HAVANA, IL 62644-1337
(309) 543-6301
(309) 543-4958
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019024184
IL
Other
Enumeration date
12/28/2012
Last updated
12/28/2012
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