Maple Shade Dental Camp Street LLC
NPI #1497003156 in East Peoria, Illinois
Provider Information
- NPI Number
- 1497003156
- Entity Type
- Organization
- Organization Name
- Maple Shade Dental Camp Street LLC
- Primary Specialty
- Dentist
- Enumeration Date
- Aug 28, 2012
- Last Updated
- Aug 28, 2012
Practice Location
- Address
- 809 W CAMP ST
- City
- East Peoria
- State
- Illinois
- ZIP Code
- 61611-7218
- Phone
- (309) 694-0606
Authorized Official
- Name
- MIKE COLE
- Title
- INSURANCE DIRECTOR
- Phone
- (727) 726-1611
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist |
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