Illinois Valley Endodontics LLC

NPI #1407031305 in Peru, Illinois

Provider Information

NPI Number: 1407031305
Entity Type: Organization
Organization Name: Illinois Valley Endodontics LLC
Primary Specialty: Dentist - Endodontics
Enumeration Date: Jan 9, 2008
Last Updated: Jan 9, 2008

Practice Location

Address: 1601 4TH ST
City: Peru
State: Illinois
ZIP Code: 61354-3507
Phone: (815) 224-3636

Authorized Official

Name: DR. LEE MICHAEL CERESA, DDS
Title: OWNER/DENTIST
Phone: (815) 224-3636

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - Endodontics — Endodontics	1223E0200X	Primary

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