| Malta Family Dental Llc | |
|
304 Van Buren St Malta IL 60150-9512 | |
| (815) 825-5025 | |
| (815) 516-0205 |
| Full Name | Malta Family Dental Llc |
|---|---|
| Speciality | Dentist |
| Location | 304 Van Buren St, Malta, Illinois |
| Authorized Official Name and Position | Anne Elizabeth Anderson (OFFICE MANAGER) |
| Authorized Official Contact | 8158255025 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Malta Family Dental Llc 304 Van Buren St Malta IL 60150-9512 Ph: (815) 825-5025 | Malta Family Dental Llc 304 Van Buren St Malta IL 60150-9512 Ph: (815) 825-5025 |
| NPI Number | 1063791218 |
|---|---|
| Provider Enumeration Date | 08/05/2011 |
| Last Update Date | 08/05/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063791218 | NPI | - | NPPES |
| 019027588 | Medicaid | IL | |
| 020010952 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 019027588 (Illinois) | Primary |
| 124Q00000X | Dental Hygienist | 020010952 (Illinois) | Secondary |