Smalltown Dental On Fourth LLC

NPI #1427775089 in Morton, Illinois

Provider Information

NPI Number: 1427775089
Entity Type: Organization
Organization Name: Smalltown Dental On Fourth LLC
Subpart: Yes (part of a larger organization)
Parent Organization: SMALLTOWN DENTAL MANAGEMENT LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Oct 25, 2022
Last Updated: Oct 25, 2022

Practice Location

Address: 1600 S 4TH AVE STE 110
City: Morton
State: Illinois
ZIP Code: 61550-3401
Phone: (309) 263-2781

Authorized Official

Name: LUKE OVERCASH
Title: CIO
Phone: (309) 370-5853

Specialties & Taxonomy Codes

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

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