| Optim Dental Bloomington LLC | |
|
401 N Veterans Pkwy Ste 4 Bloomington IL 61704-7716 | |
| (217) 971-3432 | |
| Not Available |
| Full Name | Optim Dental Bloomington LLC |
|---|---|
| Speciality | Dentist |
| Location | 401 N Veterans Pkwy Ste 4, Bloomington, Illinois |
| Authorized Official Name and Position | Mindy Schmacht (OFFICE MANAGER) |
| Authorized Official Contact | 2179713432 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Optim Dental Bloomington LLC 401 N Veterans Pkwy Ste 4 Bloomington IL 61704-7716 Ph: (217) 971-3432 | Optim Dental Bloomington LLC 401 N Veterans Pkwy Ste 4 Bloomington IL 61704-7716 Ph: (217) 971-3432 |
| NPI Number | 1902251911 |
|---|---|
| Provider Enumeration Date | 04/27/2016 |
| Last Update Date | 04/27/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902251911 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 019.0228802 (Illinois) | Primary |
| 122300000X | Dentist | 019.030202 (Illinois) | Secondary |
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