Organization
DENTAL SEALANTS & MORE
Active
Parent organization
DENTAL SEALANTS & MORE
Organization subpart
Yes
Provider details
NPI number
Legal business name
DENTAL SEALANTS & MORE
Authorized official
RENEE KATHERINE DIETZ DMD (PRESIDENT)
(309) 339-4433
Entity
Organization
Contact information
Practice address
2126 N. UNIVERSITY ST., PEORIA, IL 61604
(309) 339-4433
(309) 406-1326
Mailing address
2126 N. UNIVERSITY ST., PEORIA, IL 61604
(309) 339-4433
(309) 406-1326
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019-010639
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1001319
DORAL DENTAL OF ILLINOIS
IL
Enumeration date
03/28/2008
Last updated
02/08/2017
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