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General NPI Number Information
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NPI Number | 1215558390
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Entity Type | Organization
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Legal Business Name | VERHEECKE DENTAL LLC
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Dates
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Enumeration Date | 04/30/2020
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Last Update Date | 04/30/2020
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Provider Practice Location Address
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Address Line | 103 S MAIN ST
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City | ORANGEVILLE
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State | IL
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Zip | 61060-9244
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Country | US
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Telephone | 815-789-4611
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Fax | 815-789-4612
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Provider Business Mailing Address
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Address Line | PO BOX 456
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City | ORANGEVILLE
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State | IL
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Zip | 61060-0456
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Country | US
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Telephone | 815-789-4611
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Fax | 815-789-4612
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. PENNY K BOSE
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Credential |
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Telephone | 815-789-4611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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