Pine Glen Dental Group, Ltd in Peoria - General Practice
Pine Glen Dental Group, Ltd - NPI 1659589299
Pine Glen Dental Group, Ltd is a General Practice in Peoria, Illinois. Pine Glen Dental Group, Ltd practices all healthcare services and medical treatments related to General Practice. The NPI Number for Pine Glen Dental Group, Ltd is 1659589299. The last update date is 2020-08-22.
Pine Glen Dental Group, Ltd's current location address is 838 W Glen Ave, Peoria, Illinois. You can contact this provider via phone number 3096911990 and fax number 3096919112. The mailing address for Pine Glen Dental Group, Ltd is 838 W Glen Ave, Peoria, Illinois. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | Pine Glen Dental Group, Ltd |
|---|---|
| Address | 838 W Glen Ave, Peoria, Illinois |
| Phone Number | 3096911990 |
| Fax Number | 3096919112 |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | PRESIDENT |
|---|---|
| Authorized Official Name | Pollard Michael Robert |
| Credentials | DDS |
| Telephone Number | 3096911990 |
NPI Number Detail
| NPI Number | 1659589299 |
|---|---|
| Provider Enumeration Date | 2007-05-18 |
| Last Updated Date | 2020-08-22 |
Provider Mailing Address Detail
| Address | 838 W Glen Ave |
|---|---|
| City | Peoria |
| State | Illinois (IL) |
| Post Code | 616144835 |
| Phone Number | 3096911990 |
| Fax Number | 3096919112 |
Provider's Primary Taxonomy Detail
| Speciality | General Practice |
|---|---|
| Taxonomy | 1223G0001X |
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Definition: A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
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What is the unique 10-digit identification code issued to Pine Glen Dental Group, Ltd by the Centers for Medicare & Medicaid Services?
The Pine Glen Dental Group, Ltd has been assigned the NPI (National Provider Identifier) 1659589299 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code serves as a unique identifier for healthcare providers.
Could you share the physical location details of Pine Glen Dental Group, Ltd?
The Pine Glen Dental Group, Ltd is situated at 838 W Glen Ave, in the city of Peoria, state of IL, with the zip code 616144835.
What is Pine Glen Dental Group, Ltd's area of expertise and its corresponding taxonomy classification?
The Pine Glen Dental Group, Ltd's field of specialization is General Practice, and it falls under the taxonomy code 1223G0001X, which categorizes healthcare providers based on their areas of practice.
On what date did the Centers for Medicare & Medicaid Services assign the 1659589299 to Pine Glen Dental Group, Ltd?
The Centers for Medicare & Medicaid Services assigned the 1659589299 to Pine Glen Dental Group, Ltd on 2007-05-18.
When was the information regarding Pine Glen Dental Group, Ltd most recently updated?
The details pertaining to the Pine Glen Dental Group, Ltd, including its address, specialty, and other relevant information, were last refreshed on 2020-08-22.