Smalltown Dental Bloomington On Maloney
NPI #1023719341 in Bloomington, Illinois
Provider Information
- NPI Number
- 1023719341
- Entity Type
- Organization
- Organization Name
- Smalltown Dental Bloomington On Maloney
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- SMALLTOWN DENTAL MANAGEMENT LLC
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Mar 14, 2023
- Last Updated
- Mar 14, 2023
Practice Location
- Address
- 2433 MALONEY DR
- City
- Bloomington
- State
- Illinois
- ZIP Code
- 61704-3750
- Phone
- (309) 662-9042
Authorized Official
- Name
- LUKE OVERCASH
- Title
- CIO
- Phone
- (309) 370-5853
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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