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General NPI Number Information
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NPI Number | 1477266245
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Entity Type | Organization
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Legal Business Name | TWIN CITY DENTAL
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Dates
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Enumeration Date | 12/27/2022
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Last Update Date | 12/27/2022
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Provider Practice Location Address
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Address Line | 2102 E WASHINGTON ST
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City | BLOOMINGTON
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State | IL
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Zip | 61701-4321
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Country | US
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Telephone | 309-808-2743
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Fax |
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Provider Business Mailing Address
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Address Line | 2814 RICHARD RD
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City | BLOOMINGTON
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State | IL
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Zip | 61704-4640
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Country | US
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Telephone | 309-824-7926
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. SCOTT WILLIAM TODD
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Credential | DMD
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Telephone | 309-824-7926
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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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