Malta Family Dental LLC

NPI #1063791218 in Malta, Illinois

Provider Information

NPI Number: 1063791218
Entity Type: Organization
Organization Name: Malta Family Dental LLC
Primary Specialty: Dentist
Enumeration Date: Aug 5, 2011
Last Updated: Aug 5, 2011

Practice Location

Address: 304 VAN BUREN ST
City: Malta
State: Illinois
ZIP Code: 60150-9512
Phone: (815) 825-5025

Authorized Official

Name: MRS. ANNE ELIZABETH ANDERSON
Title: OFFICE MANAGER
Phone: (815) 825-5025

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dental Hygienist	124Q00000X
Dentist	122300000X	Primary

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