| Springfield Periodontics LLC | |
|
2025 W Iles Ave Springfield IL 62704-4190 | |
| (217) 787-6761 | |
| (217) 787-6611 |
| Full Name | Springfield Periodontics LLC |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 2025 W Iles Ave, Springfield, Illinois |
| Authorized Official Name and Position | James William Davis (PERIODONTIST) |
| Authorized Official Contact | 2177876761 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Springfield Periodontics LLC 2025 W Iles Ave Springfield IL 62704-4190 Ph: (217) 787-6761 | Springfield Periodontics LLC 2025 W Iles Ave Springfield IL 62704-4190 Ph: (217) 787-6761 |
| NPI Number | 1649342999 |
|---|---|
| Provider Enumeration Date | 11/14/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649342999 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | () | Primary |
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