Iidsm Bloomington LLC

NPI #1366710410 in Bloomington, Illinois

Provider Information

NPI Number: 1366710410
Entity Type: Organization
Organization Name: Iidsm Bloomington LLC
Primary Specialty: Dentist
Enumeration Date: Dec 5, 2011
Last Updated: May 16, 2012

Practice Location

Address: 2309 E EMPIRE ST
Address 2: 500
City: Bloomington
State: Illinois
ZIP Code: 61704-8636
Phone: (309) 319-6568

Authorized Official

Name: CAILIN SPENCER
Title: ACCOUNTS RECEIVABLE MANAGER
Phone: (309) 243-1341

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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