Provider Demographics
NPI:1356509806
Name:AFFORDABLE DENTISTRY TODAY, PC
Entity Type:Organization
Organization Name:AFFORDABLE DENTISTRY TODAY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KROEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:1200 NETWORK CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-4637
Mailing Address - Country:US
Mailing Address - Phone:217-540-5100
Mailing Address - Fax:877-635-3298
Practice Address - Street 1:1200 NETWORK CENTRE DR
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-4637
Practice Address - Country:US
Practice Address - Phone:217-540-5100
Practice Address - Fax:877-635-3298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty