| Peterson Dental Care Llc | |
|
2501 W Iles Ave Ste A Springfield IL 62704-6482 | |
| (217) 787-4015 | |
| Not Available |
| Full Name | Peterson Dental Care Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2501 W Iles Ave Ste A, Springfield, Illinois |
| Authorized Official Name and Position | James Peterson (OWNER) |
| Authorized Official Contact | 6307809964 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Peterson Dental Care Llc 1700 Mound Rd Jacksonville IL 62650-2260 Ph: (630) 780-9964 | Peterson Dental Care Llc 2501 W Iles Ave Ste A Springfield IL 62704-6482 Ph: (217) 787-4015 |
| NPI Number | 1316430952 |
|---|---|
| Provider Enumeration Date | 06/08/2018 |
| Last Update Date | 06/08/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316430952 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 019029045 (Illinois) | Primary |
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