| Liberty Dental, Inc | |
|
112 W Adams St Havana IL 62644-1337 | |
| (309) 543-6301 | |
| (309) 543-4958 |
| Full Name | Liberty Dental, Inc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 112 W Adams St, Havana, Illinois |
| Authorized Official Name and Position | Aaron James Blakely (PRESIDENT) |
| Authorized Official Contact | 3095436301 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Liberty Dental, Inc 112 W Adams St Havana IL 62644-1337 Ph: (309) 543-6301 | Liberty Dental, Inc 112 W Adams St Havana IL 62644-1337 Ph: (309) 543-6301 |
| NPI Number | 1649516295 |
|---|---|
| Provider Enumeration Date | 12/28/2012 |
| Last Update Date | 12/28/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649516295 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 019024184 (Illinois) | Primary |
Stinauer Family Dentistry Inc. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 312 W Main St, Havana, IL 62644 Phone: 309-543-2975 Fax: 309-543-2782 |