Central Illinois Center for Tmj and Facial Pain PC

NPI #1962745232 in East Peoria, Illinois

Provider Information

NPI Number: 1962745232
Entity Type: Organization
Organization Name: Central Illinois Center for Tmj and Facial Pain PC
Primary Specialty: Dentist
Enumeration Date: Apr 4, 2013
Last Updated: Apr 4, 2013

Practice Location

Address: 731 SABRINA DR
Address 2: SUITE A
City: East Peoria
State: Illinois
ZIP Code: 61611-3581
Phone: (309) 699-1300

Authorized Official

Name: DR. JACK G WALZ, DDS
Title: CEO/DIRECTOR
Phone: (309) 699-1300

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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