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NPI Code Detail

MEDICARE: DR. JAMES WILLIS PLEDGER II D.D.S

MEDICARE: DR. JAMES WILLIS PLEDGER II D.D.S
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223S0112XOral and Maxillofacial Surgery (Dentist)8334TN

General Provider Information

NPI Number : 1265599864
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES WILLIS PLEDGER II D.D.S
Provider Business Mailing Address
First Line : 2807 N KNOXVILLE AVE
Second Line :
City : PEORIA
State : IL
Zip : 61604-2869
Country : US
Telephone Number : 309-682-1213
Fax Number :
Provider Business Practice Location Address
First Line : 2807 N KNOXVILLE AVE
Second Line :
City : PEORIA
State : IL
Zip : 61604-2869
Country : US
Telephone Number : 309-682-1213
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2007
Last Update Date : 09/27/2024

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