Healthcare Provider Details

I. General information

NPI: 1982056784
Provider Name (Legal Business Name): ZUNIGA DENTAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 FLORENCE AVE
PEKIN IL
61554-2325
US

IV. Provider business mailing address

1245 FLORENCE AVE
PEKIN IL
61554-2325
US

V. Phone/Fax

Practice location:
  • Phone: 309-346-3175
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019029905
License Number StateIL

VIII. Authorized Official

Name: DR. MEGHAN JENNINGS ZUNIGA
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 309-346-3175