| Maple Shade Dental (east Peoria) Llc | |
|
1001 Illini Dr East Peoria IL 61611-1883 | |
| (309) 694-2620 | |
| Not Available |
| Full Name | Maple Shade Dental (east Peoria) Llc |
|---|---|
| Speciality | Dentist |
| Location | 1001 Illini Dr, East Peoria, Illinois |
| Authorized Official Name and Position | Mike Cole (INSURANCE DIRECTOR) |
| Authorized Official Contact | 7277261611 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Maple Shade Dental (east Peoria) Llc 6240 Lake Osprey Dr Dept 56057 Lakewood Ranch FL 34240-8421 Ph: () - | Maple Shade Dental (east Peoria) Llc 1001 Illini Dr East Peoria IL 61611-1883 Ph: (309) 694-2620 |
| NPI Number | 1245522267 |
|---|---|
| Provider Enumeration Date | 05/10/2011 |
| Last Update Date | 03/18/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245522267 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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