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General NPI Number Information
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NPI Number | 1154849966
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Entity Type | Organization
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Legal Business Name | AUSTRIACO DENTAL ASSOCIATES - PERU LLC
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Dates
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Enumeration Date | 08/31/2017
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Last Update Date | 08/31/2017
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Provider Practice Location Address
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Address Line | 5301 STATE ROUTE 251 STE A
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City | PERU
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State | IL
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Zip | 61354-9317
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Country | US
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Telephone | 815-410-3003
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3189
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City | SYRACUSE
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State | NY
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Zip | 13220-3189
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEROME AUSTRIACO
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Credential |
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Telephone | 815-410-3003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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