Provider Demographics
NPI:1346264850
Name:PRINCETON DENTAL CARE, LTD.
Entity Type:Organization
Organization Name:PRINCETON DENTAL CARE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:J
Authorized Official - Last Name:MONZON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-879-5273
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:440 EAST PERU STREET
Mailing Address - City:PRINCETON
Mailing Address - State:IL
Mailing Address - Zip Code:61356-0547
Mailing Address - Country:US
Mailing Address - Phone:815-879-5273
Mailing Address - Fax:
Practice Address - Street 1:440 E PERU ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356-2199
Practice Address - Country:US
Practice Address - Phone:815-879-5273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019023357261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental