| Mountain Bay Dental Llc | |
|
3510 Marianna Dr Champaign IL 61822-9502 | |
| (715) 496-1128 | |
| Not Available |
| Full Name | Mountain Bay Dental Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3510 Marianna Dr, Champaign, Illinois |
| Authorized Official Name and Position | Lanae W Johnson (MANAGER) |
| Authorized Official Contact | 7154961128 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountain Bay Dental Llc 5702 Memorial Ct Weston WI 54476-6502 Ph: (715) 496-1128 | Mountain Bay Dental Llc 3510 Marianna Dr Champaign IL 61822-9502 Ph: (715) 496-1128 |
| NPI Number | 1295268019 |
|---|---|
| Provider Enumeration Date | 04/08/2017 |
| Last Update Date | 04/08/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295268019 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 1001483 (Wisconsin) | Primary |
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