Granite City Dental Care Ltd

NPI #1750609418 in Champaign, Illinois

Provider Information

NPI Number: 1750609418
Entity Type: Organization
Organization Name: Granite City Dental Care Ltd
Subpart: Yes (part of a larger organization)
Parent Organization: GRANITE CITY DENTAL CARE
Primary Specialty: Dentist
Enumeration Date: May 5, 2010
Last Updated: May 5, 2010

Practice Location

Address: 2102 N MARKET ST
City: Champaign
State: Illinois
ZIP Code: 61822-1306
Phone: (618) 877-0780

Authorized Official

Name: MS. LA NAE WOOD
Title: OFFICE MANAGER
Phone: (217) 351-2650

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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