Provider Demographics
NPI:1386201226
Name:BUFFALO PRAIRIE DENTAL SURGERY AND SEDATION CENTER PLLC
Entity Type:Organization
Organization Name:BUFFALO PRAIRIE DENTAL SURGERY AND SEDATION CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAUNN
Authorized Official - Middle Name:
Authorized Official - Last Name:STURHAHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-257-0386
Mailing Address - Street 1:34626 150TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:IL
Mailing Address - Zip Code:62366-2150
Mailing Address - Country:US
Mailing Address - Phone:217-257-0386
Mailing Address - Fax:309-218-4258
Practice Address - Street 1:126 N 30TH ST STE 102
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-3719
Practice Address - Country:US
Practice Address - Phone:217-228-3384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-28
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty