Maple Shade Dental (east Peoria) LLC

NPI #1245522267 in East Peoria, Illinois

Provider Information

NPI Number: 1245522267
Entity Type: Organization
Organization Name: Maple Shade Dental (east Peoria) LLC
Primary Specialty: Dentist
Enumeration Date: May 10, 2011
Last Updated: Mar 18, 2024

Practice Location

Address: 1001 ILLINI DR
City: East Peoria
State: Illinois
ZIP Code: 61611-1883
Phone: (309) 694-2620

Authorized Official

Name: MIKE COLE
Title: INSURANCE DIRECTOR
Phone: (727) 726-1611

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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