Organization
DENTAL PROFESSIONALS OF ILLINOIS, P.C.
Active
Parent organization
DENTAL PROFESSIONALS OF ILLINOIS, P.C.
Other names
Long Creek Dental
Organization subpart
Yes
Provider details
NPI number
Legal business name
DENTAL PROFESSIONALS OF ILLINOIS, P.C.
Authorized official
HEATHER PRUEMER (CREDENTIALING TEAM LEAD)
(217) 540-8434
Entity
Organization
Contact information
Practice address
3040 S MOUNT ZION RD, DECATUR, IL 62521-9771
(217) 864-4494
Mailing address
3040 S MOUNT ZION RD, DECATUR, IL 62521-9771
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
07/26/2016
Last updated
07/26/2016
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