Pine Glen Dental Group, Ltd

NPI #1053677765 in Peoria, Illinois

Provider Information

NPI Number: 1053677765
Entity Type: Organization
Organization Name: Pine Glen Dental Group, Ltd
Primary Specialty: Dentist - General Practice
Enumeration Date: Apr 6, 2012
Last Updated: Apr 6, 2012

Practice Location

Address: 838 W GLEN AVE
City: Peoria
State: Illinois
ZIP Code: 61614-4835
Phone: (309) 691-1990

Authorized Official

Name: DR. LORI A RICE, DDS
Title: PRESIDENT
Phone: (309) 691-1990

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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