Provider Demographics
NPI:1215558390
Name:VERHEECKE DENTAL LLC
Entity Type:Organization
Organization Name:VERHEECKE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:K
Authorized Official - Last Name:BOSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-789-4611
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:ORANGEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61060-0456
Mailing Address - Country:US
Mailing Address - Phone:815-789-4611
Mailing Address - Fax:815-789-4612
Practice Address - Street 1:103 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ORANGEVILLE
Practice Address - State:IL
Practice Address - Zip Code:61060-9244
Practice Address - Country:US
Practice Address - Phone:815-789-4611
Practice Address - Fax:815-789-4612
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VERHEECKE DENTAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental