Dental Professionals of Illinois, P.c.

NPI #1720531759 in Decatur, Illinois

Provider Information

NPI Number: 1720531759
Entity Type: Organization
Organization Name: Dental Professionals of Illinois, P.c.
Subpart: Yes (part of a larger organization)
Parent Organization: DENTAL PROFESSIONALS OF ILLINOIS, P.C.
Primary Specialty: Dentist - General Practice
Enumeration Date: Jul 26, 2016
Last Updated: Jul 26, 2016

Practice Location

Address: 3040 S MOUNT ZION RD
City: Decatur
State: Illinois
ZIP Code: 62521-9771
Phone: (217) 864-4494

Authorized Official

Name: HEATHER PRUEMER
Title: CREDENTIALING TEAM LEAD
Phone: (217) 540-8434

Specialties & Taxonomy Codes

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

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