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General NPI Number Information
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NPI Number | 1386201226
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Entity Type | Organization
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Legal Business Name | BUFFALO PRAIRIE DENTAL SURGERY AND SEDATION CENTER PLLC
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Dates
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Enumeration Date | 05/28/2019
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Last Update Date | 11/02/2023
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Provider Practice Location Address
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Address Line | 126 N 30TH ST STE 102
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City | QUINCY
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State | IL
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Zip | 62301-3719
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Country | US
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Telephone | 217-228-3384
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Fax |
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Provider Business Mailing Address
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Address Line | 34626 150TH AVE
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City | PLEASANT HILL
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State | IL
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Zip | 62366-2150
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Country | US
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Telephone | 217-257-0386
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Fax | 309-218-4258
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DAUNN STURHAHN
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Credential |
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Telephone | 217-257-0386
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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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