Individual
PATRICK MCSHANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2425 W CORNERSTONE CT STE A, PEORIA, IL 61614-2495
(309) 692-3000
Mailing address
2425 W CORNERSTONE CT STE A, PEORIA, IL 61614-2495
(309) 692-3000
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
021002642
IL
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
2013043435
MO
Other
Enumeration date
02/06/2014
Last updated
05/25/2021
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