Prairie Avenue Dental Associates, Inc.

NPI #1245428234 in Hebron, Illinois

Provider Information

NPI Number: 1245428234
Entity Type: Organization
Organization Name: Prairie Avenue Dental Associates, Inc.
Subpart: Yes (part of a larger organization)
Parent Organization: RENEE E. SCHULTZ DIETZ
Primary Specialty: Dentist - General Practice
Enumeration Date: Oct 4, 2007
Last Updated: Oct 4, 2007

Practice Location

Address: 12016 PRAIRIE AVE
Address 2: POST OFFICE BOX 75
City: Hebron
State: Illinois
ZIP Code: 60034-8892
Phone: (815) 648-4095

Authorized Official

Name: DR. RENEE E. DIETZ, D.M.D.
Title: OWNER
Phone: (815) 648-4095

Specialties & Taxonomy Codes

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

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