Organization
GRANITE CITY DENTAL CARE LTD
Active
Parent organization
GRANITE CITY DENTAL CARE
Organization subpart
Yes
Provider details
NPI number
Legal business name
GRANITE CITY DENTAL CARE
Authorized official
MS. LA NAE WOOD (OFFICE MANAGER)
(217) 351-2650
Entity
Organization
Contact information
Practice address
2102 N MARKET ST, CHAMPAIGN, IL 61822-1306
(618) 877-0780
(618) 877-8450
Mailing address
2130 JOHNSON RD, GRANITE CITY, IL 62040-3961
(618) 877-0780
(618) 877-8450
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.0225511
IL
Other
Enumeration date
05/05/2010
Last updated
05/05/2010
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