Smalltown Dental Willow Knolls LLC

NPI #1699365809 in Peoria, Illinois

Provider Information

NPI Number: 1699365809
Entity Type: Organization
Organization Name: Smalltown Dental Willow Knolls LLC
Subpart: Yes (part of a larger organization)
Parent Organization: SMALLTOWN DENTAL MANAGEMENT LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Jan 21, 2021
Last Updated: Jan 21, 2021

Practice Location

Address: 6712 N MOUNTELLO DR
City: Peoria
State: Illinois
ZIP Code: 61614-2328
Phone: (309) 691-7855

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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