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NPI Code Detail

MEDICARE: DR. VIKTOR MAISTER DMD

MEDICARE:  DR. VIKTOR  MAISTER  DMD
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
11223G0001XGeneral Practice DentistryIL

General Provider Information

NPI Number : 1720154149
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. VIKTOR MAISTER DMD
Provider Business Mailing Address
First Line : 2404 E WASHINGTON ST
Second Line :
City : EAST PEORIA
State : IL
Zip : 61611-1859
Country : US
Telephone Number : 309-699-5521
Fax Number : 309-699-7050
Provider Business Practice Location Address
First Line : 2404 E WASHINGTON ST
Second Line :
City : EAST PEORIA
State : IL
Zip : 61611-1859
Country : US
Telephone Number : 309-699-5521
Fax Number : 309-699-7050
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2006
Last Update Date : 07/08/2007

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Directions to “ DR. VIKTOR MAISTER DMD” Practice Location

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