Mountain Bay Dental LLC
NPI #1295268019 in Champaign, Illinois
Provider Information
- NPI Number
- 1295268019
- Entity Type
- Organization
- Organization Name
- Mountain Bay Dental LLC
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Apr 8, 2017
- Last Updated
- Apr 8, 2017
Practice Location
Authorized Official
- Name
- MRS. LANAE W JOHNSON
- Title
- MANAGER
- Phone
- (715) 496-1128
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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