Individual
JACEY MELISSA THELEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
838 W GLEN AVE, PEORIA, IL 61614-4882
(309) 244-1655
Mailing address
201 E NORTH LAKEVIEW DR, EAST PEORIA, IL 61611-1050
(309) 922-6720
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.037106
IL
Other
Enumeration date
05/27/2026
Last updated
05/27/2026
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