Peoria Dental LLC

NPI #1992202139 in Peoria, Illinois

Provider Information

NPI Number: 1992202139
Entity Type: Organization
Organization Name: Peoria Dental LLC
Primary Specialty: Clinic/Center - Dental
Enumeration Date: Apr 12, 2018
Last Updated: Apr 12, 2018

Practice Location

Address: 7417 N KNOXVILLE AVE
City: Peoria
State: Illinois
ZIP Code: 61614-2019
Phone: (309) 981-5995

Authorized Official

Name: DR. SCOTT C BARES, DDS
Title: PRESIDENT
Phone: (309) 981-5995

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Dental — Dental	261QD0000X	Primary

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