Smalltown Dental Peoria LLC

NPI #1558962795 in Peoria, Illinois

Provider Information

NPI Number: 1558962795
Entity Type: Organization
Organization Name: Smalltown Dental Peoria LLC
Subpart: Yes (part of a larger organization)
Parent Organization: SMALLTOWN DENTAL MANAGEMENT LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Nov 4, 2020
Last Updated: Nov 4, 2020

Practice Location

Address: 2106 N KNOXVILLE AVE
City: Peoria
State: Illinois
ZIP Code: 61603-2417
Phone: (309) 685-3814

Authorized Official

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

Specialties & Taxonomy Codes

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

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