Organization
COLORADO DENTAL PROFESSIONALS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CASSANDRA PETERSEN (CREDENTIALING TEAM LEAD)
(217) 540-8972
Entity
Organization
Contact information
Practice address
1200 NETWORK CENTRE DR, EFFINGHAM, IL 62401-4602
(217) 540-5100
Mailing address
1200 NETWORK CENTRE DR, EFFINGHAM, IL 62401-4602
(217) 540-5100
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
02/15/2018
Last updated
02/15/2018
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