| Prairie Avenue Dental Associates, Inc. | |
|
12016 Prairie Ave Post Office Box 75 Hebron IL 60034-8892 | |
| (815) 648-4095 | |
| (815) 648-2881 |
| Full Name | Prairie Avenue Dental Associates, Inc. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 12016 Prairie Ave, Hebron, Illinois |
| Authorized Official Name and Position | Renee E. Dietz (OWNER) |
| Authorized Official Contact | 8156484095 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prairie Avenue Dental Associates, Inc. 12016 Prairie Ave Post Office Box 75 Hebron IL 60034-8892 Ph: (815) 648-4095 | Prairie Avenue Dental Associates, Inc. 12016 Prairie Ave Post Office Box 75 Hebron IL 60034-8892 Ph: (815) 648-4095 |
| NPI Number | 1245428234 |
|---|---|
| Provider Enumeration Date | 10/04/2007 |
| Last Update Date | 10/04/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245428234 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (Illinois) | Primary |