| Maple Shade Dental Bloomington Llc | |
|
107 S Prospect Rd Bloomington IL 61704-4403 | |
| (309) 663-0433 | |
| (309) 662-1372 |
| Full Name | Maple Shade Dental Bloomington Llc |
|---|---|
| Speciality | Dentist |
| Location | 107 S Prospect Rd, Bloomington, Illinois |
| Authorized Official Name and Position | Mike Cole (VP INSURANCE PLAN MANAGEMENT) |
| Authorized Official Contact | 7277261611 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Maple Shade Dental Bloomington Llc 107 S Prospect Rd Bloomington IL 61704-4403 Ph: () - | Maple Shade Dental Bloomington Llc 107 S Prospect Rd Bloomington IL 61704-4403 Ph: (309) 663-0433 |
| NPI Number | 1366795437 |
|---|---|
| Provider Enumeration Date | 10/26/2012 |
| Last Update Date | 04/23/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366795437 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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