Optim Dental Peoria-1 LLC

NPI #1962943290 in Peoria, Illinois

Provider Information

NPI Number: 1962943290
Entity Type: Organization
Organization Name: Optim Dental Peoria-1 LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Mar 20, 2017
Last Updated: Mar 20, 2017

Practice Location

Address: 1200 W MAIN ST STE 9
City: Peoria
State: Illinois
ZIP Code: 61606-1218
Phone: (309) 777-9777

Authorized Official

Name: SRINIVAS DURSHANAPALLI, DDS
Title: PRESIDENT
Phone: (217) 303-5955

Specialties & Taxonomy Codes

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

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