Healthcare Provider Details

I. General information

NPI: 1629900121
Provider Name (Legal Business Name): SMALLTOWN DENTAL HENRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 EDWARD ST
HENRY IL
61537-1501
US

IV. Provider business mailing address

1600 S 4TH AVE STE 110
MORTON IL
61550-3401
US

V. Phone/Fax

Practice location:
  • Phone: 309-364-3981
  • Fax:
Mailing address:
  • Phone: 309-370-5853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LUKE OVERCASH
Title or Position: CIO
Credential:
Phone: 309-370-5853